14D2112747 CLIA NUMBER - GIBSON AREA PRIMARY CARE

Laboratory Demographics

CLIA Number: 14D2112747

Facility Name: GIBSON AREA PRIMARY CARE

Facility Address:
3 DOCTOR PARK
GIBSON CITY, IL
ZIP 60936
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Facility Phone Number: 217 784-4030

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1740641745

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2112747
LAB Type	Physician Office
Facility Name	GIBSON AREA PRIMARY CARE
Street	3 DOCTOR PARK
City	GIBSON CITY
State	IL
ZIP	60936
Phone	217 784-4030
CertificateType	3
CertificateEffectiveDate	5/9/2024
CertificateExpirationDate	5/8/2026
FacilityType	PPMP

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