14D1040543 CLIA NUMBER - FRESENIUS MEDICAL CARE MCLEAN COUNTY

Laboratory Demographics

CLIA Number: 14D1040543

Facility Name: FRESENIUS MEDICAL CARE MCLEAN COUNTY

Facility Address:
1505 EASTLAND DR MEDICAL PLAZA - LOWER LEVEL
BLOOMINGTON, IL
ZIP 61701
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Facility Phone Number: 309 663-7165

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1326420563

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1040543
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS MEDICAL CARE MCLEAN COUNTY
Street	1505 EASTLAND DR MEDICAL PLAZA - LOWER LEVEL
City	BLOOMINGTON
State	IL
ZIP	61701
Phone	309 663-7165
CertificateType	4
CertificateEffectiveDate	8/19/2023
CertificateExpirationDate	8/18/2025
FacilityType	Waiver

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