14D1023184 CLIA NUMBER - HAMMOND-HENRY HOSPITAL MEDICAL GROUP - KEWANEE

Laboratory Demographics

CLIA Number: 14D1023184

Facility Name: HAMMOND-HENRY HOSPITAL MEDICAL GROUP - KEWANEE

Facility Address:
1258 W SOUTH ST
KEWANEE, IL
ZIP 61443
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Facility Phone Number: 309 853-3677

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1629517313

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1023184
LAB Type	Rural Health Clinic
Facility Name	HAMMOND-HENRY HOSPITAL MEDICAL GROUP - KEWANEE
Street	1258 W SOUTH ST
City	KEWANEE
State	IL
ZIP	61443
Phone	309 853-3677
CertificateType	4
CertificateEffectiveDate	3/9/2024
CertificateExpirationDate	3/8/2026
FacilityType	Waiver

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