14D2035815 CLIA NUMBER - PRAIRIE SURGICARE LLC

Laboratory Demographics

  • CLIA Code: 14D2035815
  • Facility Name: PRAIRIE SURGICARE LLC
  • Facility Address: 7620 N UNIVERSITY ST STE 101
    PEORIA, IL
    ZIP 61614
  • Facility Phone: 309 691-7774
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD KUBE MD
  • NPI Number: 1336408038
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2035815
LAB Type Physician Office
Facility Name PRAIRIE SURGICARE LLC
Street 7620 N UNIVERSITY ST STE 101
City PEORIA
State IL
ZIP 61614
Phone 309 691-7774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2024
Certificate Expiration Date 1/24/2026
Facility Type Physician Office
Lab Director RICHARD KUBE MD

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