14D0878378 CLIA NUMBER - CHARLOTTE ANN RUSSELL MEDICAL CENTER

Laboratory Demographics

CLIA Number: 14D0878378

Facility Name: CHARLOTTE ANN RUSSELL MEDICAL CENTER

Facility Address:
801 E ORANGE ST
HOOPESTON, IL
ZIP 60942
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Facility Phone Number: 217 283-8433

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1578504544

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0878378
LAB Type	Rural Health Clinic
Facility Name	CHARLOTTE ANN RUSSELL MEDICAL CENTER
Street	801 E ORANGE ST
City	HOOPESTON
State	IL
ZIP	60942
Phone	217 283-8433
CertificateType	4
CertificateEffectiveDate	9/12/2022
CertificateExpirationDate	9/11/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024