14D2103719 CLIA NUMBER - PERFORMANCE MEDICAL CLINIC LLC AMBROSE MEDICAL LLC

Laboratory Demographics

  • CLIA Code: 14D2103719
  • Facility Name: PERFORMANCE MEDICAL CLINIC LLC AMBROSE MEDICAL LLC
  • Facility Address: 1181 STATE ROUTE 157 - STE 100B
    EDWARDSVILLE, IL
    ZIP 62025
  • Facility Phone: 618 671-6800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL T. AMBROSE MD
  • NPI Number: 1255746715
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2103719
LAB Type Physician Office
Facility Name PERFORMANCE MEDICAL CLINIC LLC AMBROSE MEDICAL LLC
Street 1181 STATE ROUTE 157 - STE 100B
City EDWARDSVILLE
State IL
ZIP 62025
Phone 618 671-6800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2025
Certificate Expiration Date 10/19/2027
Facility Type Physician Office
Lab Director MICHAEL T. AMBROSE MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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