14D1004628 CLIA NUMBER - CENTER FOR MINIMALLY INVASIVE SURGERY

Laboratory Demographics

  • CLIA Code: 14D1004628
  • Facility Name: CENTER FOR MINIMALLY INVASIVE SURGERY
  • Facility Address: 19110 DARVIN DR, STE A
    MOKENA, IL
    ZIP 60448
  • Facility Phone: 708 478-8889
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ELISABETH C. SHEARON
  • NPI Number: 1598700841
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1004628
LAB Type Ambulatory Surgery Center
Facility Name CENTER FOR MINIMALLY INVASIVE SURGERY
Street 19110 DARVIN DR, STE A
City MOKENA
State IL
ZIP 60448
Phone 708 478-8889
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Ambulatory Surgery Center
Lab Director ELISABETH C. SHEARON

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