14D2115247 CLIA NUMBER - FOOT & ANKLE CENTER OF ILLINOIS

Laboratory Demographics

CLIA Number: 14D2115247

Facility Name: FOOT & ANKLE CENTER OF ILLINOIS

Facility Address:
2921 MONTVALE DR
SPRINGFIELD, IL
ZIP 62704
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Facility Phone Number: 217 787-2700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1598058547

Taxonomy: 213EP1101X - Podiatrist

CLIA Record

Field Name	Field Value
CLIA Number	14D2115247
LAB Type	Physician Office
Facility Name	FOOT & ANKLE CENTER OF ILLINOIS
Street	2921 MONTVALE DR
City	SPRINGFIELD
State	IL
ZIP	62704
Phone	217 787-2700
CertificateType	4
CertificateEffectiveDate	7/1/2022
CertificateExpirationDate	6/30/2024
FacilityType	Waiver

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