14D1078896 CLIA NUMBER - IRELAND GROVE CENTER FOR SURGERY

Laboratory Demographics

CLIA Number: 14D1078896

Facility Name: IRELAND GROVE CENTER FOR SURGERY

Facility Address:
3801 IRELAND GROVE RD
BLOOMINGTON, IL
ZIP 61704
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Facility Phone Number: (309) 664-0101

Facility Type: AMBULATORY SURGERY CENTER

Certificate Type: Waiver

NPI Number: 1750567442

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1078896
LAB Type	AMBULATORY SURGERY CENTER
Facility Name	IRELAND GROVE CENTER FOR SURGERY
Street	3801 IRELAND GROVE RD
City	BLOOMINGTON
State	IL
ZIP	61704
Phone	(309) 664-0101

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This page was last updated on: 5/11/2023