14D1015200 CLIA NUMBER - CROSSROADS FAMILY MEDICINE OF WAYNE CITY DEACONESS ILLINOIS CROSSROADS, INC

Laboratory Demographics

CLIA Number: 14D1015200

Facility Name: CROSSROADS FAMILY MEDICINE OF WAYNE CITY DEACONESS ILLINOIS CROSSROADS, INC

Facility Address:
1209 W ROBINSON ST
WAYNE CITY, IL
ZIP 62895
Get Directions

Facility Phone Number: 618 895-2050

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1932450772

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1015200
LAB Type	Rural Health Clinic
Facility Name	CROSSROADS FAMILY MEDICINE OF WAYNE CITY DEACONESS ILLINOIS CROSSROADS, INC
Street	1209 W ROBINSON ST
City	WAYNE CITY
State	IL
ZIP	62895
Phone	618 895-2050
CertificateType	4
CertificateEffectiveDate	11/9/2023
CertificateExpirationDate	11/8/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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