14D2168892 CLIA NUMBER - SOUTH BELOIT CLINIC

Laboratory Demographics

  • CLIA Code: 14D2168892
  • Facility Name: SOUTH BELOIT CLINIC
  • Facility Address: 1701 BLACKHAWK BLVD
    SOUTH BELOIT, IL
    ZIP 61080
  • Facility Phone: 815 389-2268
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROGE KAPOOR
  • NPI Number: 1679839773
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 14D2168892
LAB Type Physician Office
Facility Name SOUTH BELOIT CLINIC
Street 1701 BLACKHAWK BLVD
City SOUTH BELOIT
State IL
ZIP 61080
Phone 815 389-2268
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2025
Certificate Expiration Date 7/10/2027
Facility Type Physician Office
Lab Director ROGE KAPOOR

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