14D1088575 CLIA NUMBER - MEMORIAL PHYSICIAN SERVICES - JACKSONVILLE

Laboratory Demographics

  • CLIA Code: 14D1088575
  • Facility Name: MEMORIAL PHYSICIAN SERVICES - JACKSONVILLE
  • Facility Address: 15 FOUNDERS LANE, STE 100
    JACKSONVILLE, IL
    ZIP 62650
  • Facility Phone: 217 243-0300
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: STEVEN LILLPOP
  • NPI Number: 1558614867
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1088575
LAB Type Rural Health Clinic
Facility Name MEMORIAL PHYSICIAN SERVICES - JACKSONVILLE
Street 15 FOUNDERS LANE, STE 100
City JACKSONVILLE
State IL
ZIP 62650
Phone 217 243-0300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Rural Health Clinic
Lab Director STEVEN LILLPOP

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