14D0991589 CLIA NUMBER - BLOOMINGTON NORMAL HEALTHCARE SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 14D0991589
  • Facility Name: BLOOMINGTON NORMAL HEALTHCARE SURGERY CENTER
  • Facility Address: 2100 FORT JESSE ROAD
    NORMAL, IL
    ZIP 61761
  • Facility Phone: 217 855-9608
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: MICHELLE L. RIDER
  • NPI Number: 1083613327
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0991589
LAB Type Ambulatory Surgery Center
Facility Name BLOOMINGTON NORMAL HEALTHCARE SURGERY CENTER
Street 2100 FORT JESSE ROAD
City NORMAL
State IL
ZIP 61761
Phone 217 855-9608
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/25/2025
Certificate Expiration Date 9/24/2027
Facility Type Ambulatory Surgery Center
Lab Director MICHELLE L. RIDER

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