14D2005130 CLIA NUMBER - PEDIATRIC GROUP L L C

Laboratory Demographics

  • CLIA Code: 14D2005130
  • Facility Name: PEDIATRIC GROUP L L C
  • Facility Address: 310 W ST LOUIS STREET
    WEST FRANKFORT, IL
    ZIP 62896
  • Facility Phone: 618 993-0404
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PRADEEP G. REDDY
  • NPI Number: 1023582038
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2005130
LAB Type Physician Office
Facility Name PEDIATRIC GROUP L L C
Street 310 W ST LOUIS STREET
City WEST FRANKFORT
State IL
ZIP 62896
Phone 618 993-0404
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Physician Office
Lab Director PRADEEP G. REDDY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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