14D0988803 CLIA NUMBER - HEART OF ILLINOIS OB - GYN

Laboratory Demographics

CLIA Number: 14D0988803

Facility Name: HEART OF ILLINOIS OB - GYN

Facility Address:
1505 EASTLAND DR - STE 2200
BLOOMINGTON, IL
ZIP 61701
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Facility Phone Number: 309 454-3456

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1942592118

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	14D0988803
LAB Type	Physician Office
Facility Name	HEART OF ILLINOIS OB - GYN
Street	1505 EASTLAND DR - STE 2200
City	BLOOMINGTON
State	IL
ZIP	61701
Phone	309 454-3456
CertificateType	3
CertificateEffectiveDate	7/9/2023
CertificateExpirationDate	7/8/2025
FacilityType	PPMP

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