14D2138636 CLIA NUMBER - PRAIRIE CARDIOVASCULAR CONSULTANTS

Laboratory Demographics

  • CLIA Code: 14D2138636
  • Facility Name: PRAIRIE CARDIOVASCULAR CONSULTANTS
  • Facility Address: 1745 W WALNUT ST
    JACKSONVILLE, IL
    ZIP 62650
  • Facility Phone: 217 788-0706
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES BOCK
  • NPI Number: 1982714218
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2138636
LAB Type Physician Office
Facility Name PRAIRIE CARDIOVASCULAR CONSULTANTS
Street 1745 W WALNUT ST
City JACKSONVILLE
State IL
ZIP 62650
Phone 217 788-0706
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2023
Certificate Expiration Date 10/22/2025
Facility Type Physician Office
Lab Director JAMES BOCK

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