14D1006590 CLIA NUMBER - PRESENCE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 14D1006590
  • Facility Name: PRESENCE MEDICAL GROUP
  • Facility Address: 656 N CONVENT, STE B
    BOURBONNAIS, IL
    ZIP 60914
  • Facility Phone: 847 493-5336
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JORDAN GOODMAN MD
  • NPI Number: 1568458693
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 14D1006590
LAB Type Physician Office
Facility Name PRESENCE MEDICAL GROUP
Street 656 N CONVENT, STE B
City BOURBONNAIS
State IL
ZIP 60914
Phone 847 493-5336
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2024
Certificate Expiration Date 11/24/2026
Facility Type Physician Office
Lab Director JORDAN GOODMAN MD

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