14D2173863 CLIA NUMBER - BLOOMINGTON VA CLINIC

Laboratory Demographics

CLIA Number: 14D2173863

Facility Name: BLOOMINGTON VA CLINIC

Facility Address:
207 HAMILTON ROAD
BLOOMINGTON, IL
ZIP 61704
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Facility Phone Number: 309 827-3374

Facility Type: Community Clinic

Certificate Type: Accreditation

NPI Number: 1669918009

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	14D2173863
LAB Type	Community Clinic
Facility Name	BLOOMINGTON VA CLINIC
Street	207 HAMILTON ROAD
City	BLOOMINGTON
State	IL
ZIP	61704
Phone	309 827-3374
CertificateType	1
CertificateEffectiveDate	10/21/2019
CertificateExpirationDate	5/22/2026
FacilityType	Accreditation

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