14D0918525 CLIA NUMBER - PEDICLINIC PC

Laboratory Demographics

  • CLIA Code: 14D0918525
  • Facility Name: PEDICLINIC PC
  • Facility Address: 461 BROWN BLVD
    BOURBONNAIS, IL
    ZIP 60914
  • Facility Phone: 815 933-5700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOREENA M. MCBRIDE MD
  • NPI Number: 1093747636
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D0918525
LAB Type Physician Office
Facility Name PEDICLINIC PC
Street 461 BROWN BLVD
City BOURBONNAIS
State IL
ZIP 60914
Phone 815 933-5700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2024
Certificate Expiration Date 2/28/2026
Facility Type Physician Office
Lab Director DOREENA M. MCBRIDE MD

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