14D2107071 CLIA NUMBER - MISKELL MEDICAL LLC

Laboratory Demographics

  • CLIA Code: 14D2107071
  • Facility Name: MISKELL MEDICAL LLC
  • Facility Address: 218 W MADISON ST
    OTTAWA, IL
    ZIP 61350
  • Facility Phone: 815 431-1122
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JESSICA R. MISKELL
  • NPI Number: 1750756979
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 14D2107071
LAB Type Practitioner Other
Facility Name MISKELL MEDICAL LLC
Street 218 W MADISON ST
City OTTAWA
State IL
ZIP 61350
Phone 815 431-1122
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2024
Certificate Expiration Date 1/5/2026
Facility Type Practitioner Other
Lab Director JESSICA R. MISKELL

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