14D2054063 CLIA NUMBER - DERMATOLOGY & MOHS SURGERY INSTITUTE

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Laboratory Demographics

CLIA Number: 14D2054063

Facility Name: DERMATOLOGY & MOHS SURGERY INSTITUTE

Facility Address:
303 N HERSHEY RD
BLOOMINGTON, IL
ZIP 61704
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Facility Phone Number: 309 451-3376

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1770828626

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	14D2054063
LAB Type	Physician Office
Facility Name	DERMATOLOGY & MOHS SURGERY INSTITUTE
Street	303 N HERSHEY RD
City	BLOOMINGTON
State	IL
ZIP	61704
Phone	309 451-3376
CertificateType	2
CertificateEffectiveDate	10/11/2021
CertificateExpirationDate	4/30/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024