14D0891029 CLIA NUMBER - GIBSON AREA MEDICAL CLINIC #8

Laboratory Demographics

CLIA Number: 14D0891029

Facility Name: GIBSON AREA MEDICAL CLINIC #8

Facility Address:
8 DOCTORS PARK
GIBSON CITY, IL
ZIP 60936
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Facility Phone Number: 217 784-4086

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154702181

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0891029
LAB Type	Physician Office
Facility Name	GIBSON AREA MEDICAL CLINIC #8
Street	8 DOCTORS PARK
City	GIBSON CITY
State	IL
ZIP	60936
Phone	217 784-4086
CertificateType	4
CertificateEffectiveDate	8/30/2022
CertificateExpirationDate	8/29/2024
FacilityType	Waiver

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