14D1073210 CLIA NUMBER - PRAIRIE CARDIOVASCULAR CONSULTANTS PRAIRIE HEART INSTITUTE

Laboratory Demographics

  • CLIA Code: 14D1073210
  • Facility Name: PRAIRIE CARDIOVASCULAR CONSULTANTS PRAIRIE HEART INSTITUTE
  • Facility Address: 619 E MASON ST STE 4P57
    SPRINGFIELD, IL
    ZIP 62701
  • Facility Phone: 217 788-0706
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES BOCK
  • NPI Number: 1659539559
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1073210
LAB Type Physician Office
Facility Name PRAIRIE CARDIOVASCULAR CONSULTANTS PRAIRIE HEART INSTITUTE
Street 619 E MASON ST STE 4P57
City SPRINGFIELD
State IL
ZIP 62701
Phone 217 788-0706
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2025
Certificate Expiration Date 9/4/2027
Facility Type Physician Office
Lab Director JAMES BOCK

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