14D0884117 CLIA NUMBER - RIVERSIDE MEDICAL GROUP PED SPECIALISTS BRADLEY

Laboratory Demographics

  • CLIA Code: 14D0884117
  • Facility Name: RIVERSIDE MEDICAL GROUP PED SPECIALISTS BRADLEY
  • Facility Address: 400 S KENNEDY DR STE 900
    BRADLEY, IL
    ZIP 60915
  • Facility Phone: 815 936-8963
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FEDERICO HERRERA
  • NPI Number: 1609903574
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D0884117
LAB Type Physician Office
Facility Name RIVERSIDE MEDICAL GROUP PED SPECIALISTS BRADLEY
Street 400 S KENNEDY DR STE 900
City BRADLEY
State IL
ZIP 60915
Phone 815 936-8963
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2025
Certificate Expiration Date 7/20/2027
Facility Type Physician Office
Lab Director FEDERICO HERRERA

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