14D0870837 CLIA NUMBER - PREMIER MEDICAL GROUP LLC

Laboratory Demographics

  • CLIA Code: 14D0870837
  • Facility Name: PREMIER MEDICAL GROUP LLC
  • Facility Address: 1401 EASTLAND DR STE B
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 309 663-9424
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BENJAMIN LEAK MD
  • NPI Number: 1427357227
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 14D0870837
LAB Type Physician Office
Facility Name PREMIER MEDICAL GROUP LLC
Street 1401 EASTLAND DR STE B
City BLOOMINGTON
State IL
ZIP 61701
Phone 309 663-9424
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/8/2024
Certificate Expiration Date 10/7/2026
Facility Type Physician Office
Lab Director BENJAMIN LEAK MD

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This page was last updated on: 9/29/2025