14D0938790 CLIA NUMBER - A H M G MANTENO

Laboratory Demographics

  • CLIA Code: 14D0938790
  • Facility Name: A H M G MANTENO
  • Facility Address: 501 S LOCUST ST
    MANTENO, IL
    ZIP 60950
  • Facility Phone: 815 468-6737
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RHODORA R. SY M D
  • NPI Number: 1144761503
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 14D0938790
LAB Type Physician Office
Facility Name A H M G MANTENO
Street 501 S LOCUST ST
City MANTENO
State IL
ZIP 60950
Phone 815 468-6737
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type Physician Office
Lab Director RHODORA R. SY M D

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