14D1009257 CLIA NUMBER - DEACONESS IL CROSSROADS FAMILY CLINIC - MT VERNON

Laboratory Demographics

  • CLIA Code: 14D1009257
  • Facility Name: DEACONESS IL CROSSROADS FAMILY CLINIC - MT VERNON
  • Facility Address: 4101 N WATER TOWER PLACE
    MOUNT VERNON, IL
    ZIP 62864
  • Facility Phone: 618 244-6222
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: WILLIAM D. HUFFSTUTLER
  • NPI Number: 1790779874
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1009257
LAB Type Rural Health Clinic
Facility Name DEACONESS IL CROSSROADS FAMILY CLINIC - MT VERNON
Street 4101 N WATER TOWER PLACE
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 244-6222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2025
Certificate Expiration Date 2/10/2027
Facility Type Rural Health Clinic
Lab Director WILLIAM D. HUFFSTUTLER

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