14D2188279 CLIA NUMBER - ADVANCED IMAGING CENTER L L C

Laboratory Demographics

CLIA Number: 14D2188279

Facility Name: ADVANCED IMAGING CENTER L L C

Facility Address:
615 VALLEY VIEW DR - STE 101
MOLINE, IL
ZIP 61265
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Facility Phone Number: 309 743-0445

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1619964467

Taxonomy: 261QR0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2188279
LAB Type	Independent
Facility Name	ADVANCED IMAGING CENTER L L C
Street	615 VALLEY VIEW DR - STE 101
City	MOLINE
State	IL
ZIP	61265
Phone	309 743-0445
CertificateType	4
CertificateEffectiveDate	7/15/2022
CertificateExpirationDate	7/14/2024
FacilityType	Waiver

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