14D2070522 CLIA NUMBER - OSFMG PEDIATRICS BLOOMINGTON

Laboratory Demographics

  • CLIA Code: 14D2070522
  • Facility Name: OSFMG PEDIATRICS BLOOMINGTON
  • Facility Address: 302 ST JOSEPH DR
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: 309 664-3100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. ENDRIS
  • NPI Number: 1871050237
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 14D2070522
LAB Type Physician Office
Facility Name OSFMG PEDIATRICS BLOOMINGTON
Street 302 ST JOSEPH DR
City BLOOMINGTON
State IL
ZIP 61701
Phone 309 664-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Physician Office
Lab Director MICHAEL J. ENDRIS

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