14D2124657 CLIA NUMBER - CHESTNUT FAMILY HEALTH CENTER 702

Laboratory Demographics

  • CLIA Code: 14D2124657
  • Facility Name: CHESTNUT FAMILY HEALTH CENTER 702
  • Facility Address: 702 W CHESTNUT ST
    BLOOMINGTON, IL
    ZIP 61701
  • Facility Phone: (309) 557-1400
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: JARED C. ROGERS
  • NPI Number: 1790055952
  • Taxonomy: 261QF0400X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2124657
LAB Type Federally Qualified Health Center
Facility Name CHESTNUT FAMILY HEALTH CENTER 702
Street 702 W CHESTNUT ST
City BLOOMINGTON
State IL
ZIP 61701
Phone 3095571400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2025
Certificate Expiration Date 1/22/2027
Facility Type Federally Qualified Health Center
Lab Director JARED C. ROGERS

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: 5/18/2026