14D0926847 CLIA NUMBER - MEMORIAL PHYSICIAN SERVICES - KOKE MILL

Laboratory Demographics

  • CLIA Code: 14D0926847
  • Facility Name: MEMORIAL PHYSICIAN SERVICES - KOKE MILL
  • Facility Address: 3132 OLD JACKSONVILLE ROAD SUITE 200
    SPRINGFIELD, IL
    ZIP 62704
  • Facility Phone: 217 862-0800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID SANDERCOCK
  • NPI Number: 1063961936
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 14D0926847
LAB Type Physician Office
Facility Name MEMORIAL PHYSICIAN SERVICES - KOKE MILL
Street 3132 OLD JACKSONVILLE ROAD SUITE 200
City SPRINGFIELD
State IL
ZIP 62704
Phone 217 862-0800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/2/2025
Certificate Expiration Date 4/1/2027
Facility Type Physician Office
Lab Director DAVID SANDERCOCK

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