14D2046146 CLIA NUMBER - CHESTNUT FAMILY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 14D2046146
  • Facility Name: CHESTNUT FAMILY HEALTH CENTER
  • Facility Address: 720 W CHESTNUT ST
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 618 512-1854
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: JARED C. ROGERS
  • NPI Number: 1790055952
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2046146
LAB Type Federally Qualified Health Center
Facility Name CHESTNUT FAMILY HEALTH CENTER
Street 720 W CHESTNUT ST
City BLOOMINGTON
State IL
ZIP 61701
Phone 618 512-1854
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2024
Certificate Expiration Date 8/27/2026
Facility Type Federally Qualified Health Center
Lab Director JARED C. ROGERS

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