14D2009869 CLIA NUMBER - QUINCY MEDICAL GROUP - PEDIATRICS

Laboratory Demographics

  • CLIA Code: 14D2009869
  • Facility Name: QUINCY MEDICAL GROUP - PEDIATRICS
  • Facility Address: 1025 MAINE ST - FIRST FLOOR
    QUINCY, IL
    ZIP 62301
  • Facility Phone: 217 222-6550
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: RICHARD K. NOBLE
  • NPI Number: 1639711120
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 14D2009869
LAB Type Rural Health Clinic
Facility Name QUINCY MEDICAL GROUP - PEDIATRICS
Street 1025 MAINE ST - FIRST FLOOR
City QUINCY
State IL
ZIP 62301
Phone 217 222-6550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/15/2024
Certificate Expiration Date 7/14/2026
Facility Type Rural Health Clinic
Lab Director RICHARD K. NOBLE

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