14D0903214 CLIA NUMBER - SSM HEALTH CARDINAL GLENNON PEDIATRICS

Laboratory Demographics

  • CLIA Code: 14D0903214
  • Facility Name: SSM HEALTH CARDINAL GLENNON PEDIATRICS
  • Facility Address: 3165 MYRTLE AVE - STE 2
    GRANITE CITY, IL
    ZIP 62040
  • Facility Phone: 618 876-7500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMIL Z. RANA
  • NPI Number: 1003981770
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D0903214
LAB Type Physician Office
Facility Name SSM HEALTH CARDINAL GLENNON PEDIATRICS
Street 3165 MYRTLE AVE - STE 2
City GRANITE CITY
State IL
ZIP 62040
Phone 618 876-7500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2024
Certificate Expiration Date 5/29/2026
Facility Type Physician Office
Lab Director JAMIL Z. RANA

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