14D1072942 CLIA NUMBER - MILLER UROGYNECOLOGY

Laboratory Demographics

CLIA Number: 14D1072942

Facility Name: MILLER UROGYNECOLOGY

Facility Address:
107 N REGENCY DRIVE, SUITE 2
BLOOMINGTON, IL
ZIP 61701
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Facility Phone Number: 309 665-0900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1801088067

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	14D1072942
LAB Type	Physician Office
Facility Name	MILLER UROGYNECOLOGY
Street	107 N REGENCY DRIVE, SUITE 2
City	BLOOMINGTON
State	IL
ZIP	61701
Phone	309 665-0900
CertificateType	4
CertificateEffectiveDate	8/28/2023
CertificateExpirationDate	8/27/2025
FacilityType	Waiver

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