14D0894045 CLIA NUMBER - CHESTNUT HEALTH SYSTEMS

Laboratory Demographics

  • CLIA Code: 14D0894045
  • Facility Name: CHESTNUT HEALTH SYSTEMS
  • Facility Address: 1003 MARTIN LUTHER KING DR
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 618 512-1854
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: MATTHEW S. MOLLENHAUER
  • NPI Number: 1205907763
  • Taxonomy: 101YP2500X - Counselor

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CLIA Record

Field Name Field Value
CLIA Number 14D0894045
LAB Type Community Clinic
Facility Name CHESTNUT HEALTH SYSTEMS
Street 1003 MARTIN LUTHER KING DR
City BLOOMINGTON
State IL
ZIP 61701
Phone 618 512-1854
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Community Clinic
Lab Director MATTHEW S. MOLLENHAUER

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