14D1027352 CLIA NUMBER - MEDICAL RESOURCE CENTER

Laboratory Demographics

  • CLIA Code: 14D1027352
  • Facility Name: MEDICAL RESOURCE CENTER
  • Facility Address: 6550 E RIVERSIDE BLVD
    LOVES PARK, IL
    ZIP 61111
  • Facility Phone: 815 633-4100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEVEN J. DISANTI
  • NPI Number: 1770507295
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 14D1027352
LAB Type Physician Office
Facility Name MEDICAL RESOURCE CENTER
Street 6550 E RIVERSIDE BLVD
City LOVES PARK
State IL
ZIP 61111
Phone 815 633-4100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2024
Certificate Expiration Date 6/27/2026
Facility Type Physician Office
Lab Director STEVEN J. DISANTI

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