14D1045949 CLIA NUMBER - MEMORIAL CARE IN SULLIVAN DECATUR MEMORIAL HOSPITAL

Laboratory Demographics

  • CLIA Code: 14D1045949
  • Facility Name: MEMORIAL CARE IN SULLIVAN DECATUR MEMORIAL HOSPITAL
  • Facility Address: 1220 W JACKSON
    SULLIVAN, IL
    ZIP 61951
  • Facility Phone: 217 728-2042
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMMAD TABATABAEI PA
  • NPI Number: 1386277556
  • Taxonomy: 314000000X - Skilled Nursing Facility

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D1045949
LAB Type Physician Office
Facility Name MEMORIAL CARE IN SULLIVAN DECATUR MEMORIAL HOSPITAL
Street 1220 W JACKSON
City SULLIVAN
State IL
ZIP 61951
Phone 217 728-2042
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/22/2025
Certificate Expiration Date 1/21/2027
Facility Type Physician Office
Lab Director MOHAMMAD TABATABAEI PA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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