14D0979908 CLIA NUMBER - SSM MEDICAL GROUP/MARYVILLE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 14D0979908
  • Facility Name: SSM MEDICAL GROUP/MARYVILLE PEDIATRICS
  • Facility Address: 2133 VADALABENE DR - STE 6
    MARYVILLE, IL
    ZIP 62062
  • Facility Phone: 618 288-5084
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER D. KRICK M D
  • NPI Number: 1538342621
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0979908
LAB Type Physician Office
Facility Name SSM MEDICAL GROUP/MARYVILLE PEDIATRICS
Street 2133 VADALABENE DR - STE 6
City MARYVILLE
State IL
ZIP 62062
Phone 618 288-5084
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2024
Certificate Expiration Date 11/2/2026
Facility Type Physician Office
Lab Director JENNIFER D. KRICK M D

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