14D0993472 CLIA NUMBER - DURAND BRANCH - MONROE CLINIC

Laboratory Demographics

CLIA Number: 14D0993472

Facility Name: DURAND BRANCH - MONROE CLINIC

Facility Address:
400 S CENTER ST
DURAND, IL
ZIP 61024
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Facility Phone Number: 815 248-3443

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1215092358

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	14D0993472
LAB Type	Physician Office
Facility Name	DURAND BRANCH - MONROE CLINIC
Street	400 S CENTER ST
City	DURAND
State	IL
ZIP	61024
Phone	815 248-3443
CertificateType	4
CertificateEffectiveDate	6/9/2023
CertificateExpirationDate	6/8/2025
FacilityType	Waiver

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