14D0934419 CLIA NUMBER - CCH MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 14D0934419
  • Facility Name: CCH MEDICAL CLINIC
  • Facility Address: 929 STACY BURK DRIVE PO BOX 40
    FLORA, IL
    ZIP 62839
  • Facility Phone: 618 662-2191
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: BRANDON CYCHOLL MD
  • NPI Number: 1811946411
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0934419
LAB Type Community Clinic
Facility Name CCH MEDICAL CLINIC
Street 929 STACY BURK DRIVE PO BOX 40
City FLORA
State IL
ZIP 62839
Phone 618 662-2191
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/25/2024
Certificate Expiration Date 9/24/2026
Facility Type Community Clinic
Lab Director BRANDON CYCHOLL MD

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