14D0999001 CLIA NUMBER - SSM HEALTH MONROE CLINIC MEDICAL GROUP

Laboratory Demographics

CLIA Number: 14D0999001

Facility Name: SSM HEALTH MONROE CLINIC MEDICAL GROUP

Facility Address:
3103 KUNKLE BLVD
FREEPORT, IL
ZIP 61032
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Facility Phone Number: 815 233-0999

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1093713364

Taxonomy: 363LW0102X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	14D0999001
LAB Type	Physician Office
Facility Name	SSM HEALTH MONROE CLINIC MEDICAL GROUP
Street	3103 KUNKLE BLVD
City	FREEPORT
State	IL
ZIP	61032
Phone	815 233-0999
CertificateType	1
CertificateEffectiveDate	4/11/2024
CertificateExpirationDate	4/10/2026
FacilityType	Accreditation

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