14D0921644 CLIA NUMBER - DERMATOLOGY CARE CENTER LTD

Laboratory Demographics

  • CLIA Code: 14D0921644
  • Facility Name: DERMATOLOGY CARE CENTER LTD
  • Facility Address: 22 PROFESSIONAL PARK DR
    MARYVILLE, IL
    ZIP 62062
  • Facility Phone: 618 288-0998
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHARLES D. CONNOR M D
  • NPI Number: 1619271939
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 14D0921644
LAB Type Physician Office
Facility Name DERMATOLOGY CARE CENTER LTD
Street 22 PROFESSIONAL PARK DR
City MARYVILLE
State IL
ZIP 62062
Phone 618 288-0998
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 4/14/2024
Certificate Expiration Date 4/13/2026
Facility Type Physician Office
Lab Director CHARLES D. CONNOR M D

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