14D1100853 CLIA NUMBER - ALLIANCE INTERNAL MEDICINE S C

Laboratory Demographics

  • CLIA Code: 14D1100853
  • Facility Name: ALLIANCE INTERNAL MEDICINE S C
  • Facility Address: 370 LARRY POWER ROAD, SUITE #2
    BOURBONNAIS, IL
    ZIP 60914
  • Facility Phone: 815 545-8397
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOEL P. VILLEGAS
  • NPI Number: 1710120696
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1100853
LAB Type Physician Office
Facility Name ALLIANCE INTERNAL MEDICINE S C
Street 370 LARRY POWER ROAD, SUITE #2
City BOURBONNAIS
State IL
ZIP 60914
Phone 815 545-8397
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2025
Certificate Expiration Date 6/14/2027
Facility Type Physician Office
Lab Director JOEL P. VILLEGAS

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