14D0955814 CLIA NUMBER - PEDIATRIC GROUP L L C

Laboratory Demographics

  • CLIA Code: 14D0955814
  • Facility Name: PEDIATRIC GROUP L L C
  • Facility Address: 3412 OFFICE PARK DRIVE
    MARION, IL
    ZIP 62959
  • Facility Phone: 618 993-0404
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PRADEEP G. REDDY
  • NPI Number: 1487290615
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D0955814
LAB Type Physician Office
Facility Name PEDIATRIC GROUP L L C
Street 3412 OFFICE PARK DRIVE
City MARION
State IL
ZIP 62959
Phone 618 993-0404
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Physician Office
Lab Director PRADEEP G. REDDY

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