14D2136041 CLIA NUMBER - FAMILY MEDICINE CARBONDALE - OLDENHAGE HUGHES BLDG

Laboratory Demographics

  • CLIA Code: 14D2136041
  • Facility Name: FAMILY MEDICINE CARBONDALE - OLDENHAGE HUGHES BLDG
  • Facility Address: 207 W JACKSON STREET, SUITE 101
    CARBONDALE, IL
    ZIP 62901
  • Facility Phone: 618 457-6787
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREW J. HOSSLER MD
  • NPI Number: 1710392428
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2136041
LAB Type Physician Office
Facility Name FAMILY MEDICINE CARBONDALE - OLDENHAGE HUGHES BLDG
Street 207 W JACKSON STREET, SUITE 101
City CARBONDALE
State IL
ZIP 62901
Phone 618 457-6787
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Physician Office
Lab Director ANDREW J. HOSSLER MD

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This page was last updated on: 6/4/2025