14D2086592 CLIA NUMBER - HSHS MED GROUP GENERAL SURGERY-BREESE

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Laboratory Demographics

CLIA Number: 14D2086592

Facility Name: HSHS MED GROUP GENERAL SURGERY-BREESE

Facility Address:
9515 HOLY CROSS LN, STE 175
BREESE, IL
ZIP 62230
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Facility Phone Number: 618 526-8430

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740677533

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	14D2086592
LAB Type	Physician Office
Facility Name	HSHS MED GROUP GENERAL SURGERY-BREESE
Street	9515 HOLY CROSS LN, STE 175
City	BREESE
State	IL
ZIP	62230
Phone	618 526-8430
CertificateType	4
CertificateEffectiveDate	11/6/2022
CertificateExpirationDate	11/5/2024
FacilityType	Waiver

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