14D2072845 CLIA NUMBER - CENTRAL ILLINOIS ORAL SURGERY

Laboratory Demographics

  • CLIA Code: 14D2072845
  • Facility Name: CENTRAL ILLINOIS ORAL SURGERY
  • Facility Address: 100 GREENVIEW DR
    EFFINGHAM, IL
    ZIP 62401
  • Facility Phone: 217 540-5348
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS W. FONNER
  • NPI Number: 1801240494
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D2072845
LAB Type Physician Office
Facility Name CENTRAL ILLINOIS ORAL SURGERY
Street 100 GREENVIEW DR
City EFFINGHAM
State IL
ZIP 62401
Phone 217 540-5348
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2024
Certificate Expiration Date 2/5/2026
Facility Type Physician Office
Lab Director THOMAS W. FONNER

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