14D2142716 CLIA NUMBER - CHRISTIE CLINIC DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 14D2142716
  • Facility Name: CHRISTIE CLINIC DERMATOLOGY
  • Facility Address: 1001 COMMERCIAL DRIVE
    MAHOMET, IL
    ZIP 61853
  • Facility Phone: 217 366-1248
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CAITLYN FOOTE M D
  • NPI Number: 1447840103
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 14D2142716
LAB Type Physician Office
Facility Name CHRISTIE CLINIC DERMATOLOGY
Street 1001 COMMERCIAL DRIVE
City MAHOMET
State IL
ZIP 61853
Phone 217 366-1248
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/18/2024
Certificate Expiration Date 1/17/2026
Facility Type Physician Office
Lab Director CAITLYN FOOTE M D

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