14D2163599 CLIA NUMBER - MONCLAIR FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 14D2163599
  • Facility Name: MONCLAIR FAMILY PRACTICE
  • Facility Address: 1000 ELEVEN S - STE 2B
    COLUMBIA, IL
    ZIP 62236
  • Facility Phone: 618 772-1515
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TAMI L. BOREN
  • NPI Number: 1043774342
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2163599
LAB Type Practitioner Other
Facility Name MONCLAIR FAMILY PRACTICE
Street 1000 ELEVEN S - STE 2B
City COLUMBIA
State IL
ZIP 62236
Phone 618 772-1515
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2025
Certificate Expiration Date 3/17/2027
Facility Type Practitioner Other
Lab Director TAMI L. BOREN

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