14D2149079 CLIA NUMBER - OSF ON CALL URGENT CARE -PEORIA KNOXVILLE CROSSING

Laboratory Demographics

CLIA Number: 14D2149079

Facility Name: OSF ON CALL URGENT CARE -PEORIA KNOXVILLE CROSSING

Facility Address:
10408 N CENTERWAY DR - STE C, D & E
PEORIA, IL
ZIP 61615
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Facility Phone Number: 309 683-7253

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1982170734

Taxonomy: 332900000X - Non-Pharmacy Dispensing Site
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

CLIA Record

Field Name	Field Value
CLIA Number	14D2149079
LAB Type	Physician Office
Facility Name	OSF ON CALL URGENT CARE -PEORIA KNOXVILLE CROSSING
Street	10408 N CENTERWAY DR - STE C, D & E
City	PEORIA
State	IL
ZIP	61615
Phone	309 683-7253
CertificateType	4
CertificateEffectiveDate	5/24/2022
CertificateExpirationDate	5/23/2024
FacilityType	Waiver

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