14D0967594 CLIA NUMBER - JCH MEDICAL GROUP JERSEY COMMUNITY HOSPITAL D/B/A

Laboratory Demographics

CLIA Number: 14D0967594

Facility Name: JCH MEDICAL GROUP JERSEY COMMUNITY HOSPITAL D/B/A

Facility Address:
2 MYRTLE LANE
HARDIN, IL
ZIP 62047
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Facility Phone Number: 618 576-9407

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417352527

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0967594
LAB Type	Physician Office
Facility Name	JCH MEDICAL GROUP JERSEY COMMUNITY HOSPITAL D/B/A
Street	2 MYRTLE LANE
City	HARDIN
State	IL
ZIP	62047
Phone	618 576-9407
CertificateType	4
CertificateEffectiveDate	3/8/2024
CertificateExpirationDate	3/7/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024