14D0889480 CLIA NUMBER - ROBERT D CHILDERS MD

Laboratory Demographics

  • CLIA Code: 14D0889480
  • Facility Name: ROBERT D CHILDERS MD
  • Facility Address: 400 MAPLE SUMMIT ROAD
    JERSEYVILLE, IL
    ZIP 62052
  • Facility Phone: 618 498-8470
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROBERT D. CHILDERS MD
  • NPI Number: 1760477376
  • Taxonomy: 208800000X - Urology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D0889480
LAB Type Physician Office
Facility Name ROBERT D CHILDERS MD
Street 400 MAPLE SUMMIT ROAD
City JERSEYVILLE
State IL
ZIP 62052
Phone 618 498-8470
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 7/29/2024
Certificate Expiration Date 7/28/2026
Facility Type Physician Office
Lab Director ROBERT D. CHILDERS MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 3/20/2025