14D2179272 CLIA NUMBER - H S H S ST ANTHONY'S DIAGNOSTIC CTR-MATTOON STE B

Laboratory Demographics

CLIA Number: 14D2179272

Facility Name: H S H S ST ANTHONY'S DIAGNOSTIC CTR-MATTOON STE B

Facility Address:
101 COLES CENTER PKWY
MATTOON, IL
ZIP 61938
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Facility Phone Number: 217 347-1768

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1043831134

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2179272
LAB Type	Community Clinic
Facility Name	H S H S ST ANTHONY'S DIAGNOSTIC CTR-MATTOON STE B
Street	101 COLES CENTER PKWY
City	MATTOON
State	IL
ZIP	61938
Phone	217 347-1768
CertificateType	4
CertificateEffectiveDate	2/19/2024
CertificateExpirationDate	2/18/2026
FacilityType	Waiver

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