14D2015874 CLIA NUMBER - CENTRAL ILLINOIS FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 14D2015874
  • Facility Name: CENTRAL ILLINOIS FAMILY PRACTICE
  • Facility Address: 1017 W WILLIAMS
    DANVILLE, IL
    ZIP 61832
  • Facility Phone: 217 213-5254
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL C. WAGNER
  • NPI Number: 1558665596
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 14D2015874
LAB Type Physician Office
Facility Name CENTRAL ILLINOIS FAMILY PRACTICE
Street 1017 W WILLIAMS
City DANVILLE
State IL
ZIP 61832
Phone 217 213-5254
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2024
Certificate Expiration Date 11/7/2026
Facility Type Physician Office
Lab Director MICHAEL C. WAGNER

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