14D2070993 CLIA NUMBER - COMWELL

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Laboratory Demographics

CLIA Number: 14D2070993

Facility Name: COMWELL

Facility Address:
10257 STATE ROUTE 3
RED BUD, IL
ZIP 62278
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Facility Phone Number: 618 282-6233

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1356563563

Taxonomy: 261QR0405X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2070993
LAB Type	Community Clinic
Facility Name	COMWELL
Street	10257 STATE ROUTE 3
City	RED BUD
State	IL
ZIP	62278
Phone	618 282-6233
CertificateType	4
CertificateEffectiveDate	12/31/2023
CertificateExpirationDate	12/30/2025
FacilityType	Waiver

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