14D2112072 CLIA NUMBER - MID-CENTRAL ILLINOIS GASTROENTEROLOGY, LTD

Laboratory Demographics

  • CLIA Code: 14D2112072
  • Facility Name: MID-CENTRAL ILLINOIS GASTROENTEROLOGY, LTD
  • Facility Address: 2200 JACOBSON DRIVE SUITE B
    NORMAL, IL
    ZIP 61761
  • Facility Phone: 309 451-1123
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHEN MATTER
  • NPI Number: 1992845358
  • Taxonomy: 207RG0100X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2112072
LAB Type Physician Office
Facility Name MID-CENTRAL ILLINOIS GASTROENTEROLOGY, LTD
Street 2200 JACOBSON DRIVE SUITE B
City NORMAL
State IL
ZIP 61761
Phone 309 451-1123
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2024
Certificate Expiration Date 4/20/2026
Facility Type Physician Office
Lab Director STEPHEN MATTER

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