14D2177407 CLIA NUMBER - PEDIATRIC GROUP, L L C

Laboratory Demographics

  • CLIA Code: 14D2177407
  • Facility Name: PEDIATRIC GROUP, L L C
  • Facility Address: 130 S LINCOLN BLVD
    CENTRALIA, IL
    ZIP 62801
  • Facility Phone: 618 993-0404
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PRADEEP G. REDDY M D
  • NPI Number: 1114129970
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2177407
LAB Type Physician Office
Facility Name PEDIATRIC GROUP, L L C
Street 130 S LINCOLN BLVD
City CENTRALIA
State IL
ZIP 62801
Phone 618 993-0404
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2024
Certificate Expiration Date 1/8/2026
Facility Type Physician Office
Lab Director PRADEEP G. REDDY M D

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