14D2189865 CLIA NUMBER - AUGUSTANA CONVENIENT CARE CLINICS-PWRD BY GENESIS

Laboratory Demographics

  • CLIA Code: 14D2189865
  • Facility Name: AUGUSTANA CONVENIENT CARE CLINICS-PWRD BY GENESIS
  • Facility Address: 3410 9 1/2 AVE
    ROCK ISLAND, IL
    ZIP 61201
  • Facility Phone: 309 281-2300
  • Facility Type: Other - CLINIC
  • Facility Type: Waiver
  • Lab Director: ROBERT D. MIXSELL M D
  • NPI Number: 1831433416
  • Taxonomy: 237600000X - Audiologist-Hearing Aid Fitter

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CLIA Record

Field Name Field Value
CLIA Number 14D2189865
LAB Type Other - CLINIC
Facility Name AUGUSTANA CONVENIENT CARE CLINICS-PWRD BY GENESIS
Street 3410 9 1/2 AVE
City ROCK ISLAND
State IL
ZIP 61201
Phone 309 281-2300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/6/2024
Certificate Expiration Date 8/5/2026
Facility Type Other - CLINIC
Lab Director ROBERT D. MIXSELL M D

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