14D0984682 CLIA NUMBER - SPRINGFIELD CLINIC CARLINVILLE

Laboratory Demographics

CLIA Number: 14D0984682

Facility Name: SPRINGFIELD CLINIC CARLINVILLE

Facility Address:
20613 N BROAD ST
CARLINVILLE, IL
ZIP 62626
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Facility Phone Number: 217 854-5099

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1437369030

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0984682
LAB Type	Physician Office
Facility Name	SPRINGFIELD CLINIC CARLINVILLE
Street	20613 N BROAD ST
City	CARLINVILLE
State	IL
ZIP	62626
Phone	217 854-5099
CertificateType	4
CertificateEffectiveDate	11/3/2023
CertificateExpirationDate	11/2/2025
FacilityType	Waiver

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