14D2063164 CLIA NUMBER - SARAH DUTTA, OB-GYN, S C

Laboratory Demographics

  • CLIA Code: 14D2063164
  • Facility Name: SARAH DUTTA, OB-GYN, S C
  • Facility Address: 107 N REGENCY DR, STE 3
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 309 661-0406
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SARAH DUTTA
  • NPI Number: 1275975146
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 14D2063164
LAB Type Physician Office
Facility Name SARAH DUTTA, OB-GYN, S C
Street 107 N REGENCY DR, STE 3
City BLOOMINGTON
State IL
ZIP 61701
Phone 309 661-0406
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/29/2025
Certificate Expiration Date 7/28/2027
Facility Type Physician Office
Lab Director SARAH DUTTA

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