14D2193071 CLIA NUMBER - CARLE WEST PHYSICIAN GROUP - BLOOMINGTON CONV CARE

Laboratory Demographics

  • CLIA Code: 14D2193071
  • Facility Name: CARLE WEST PHYSICIAN GROUP - BLOOMINGTON CONV CARE
  • Facility Address: 3024 E EMPIRE - FIRST FLOOR
    BLOOMINGTON, IL
    ZIP 61704
  • Facility Phone: 309 556-7556
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEPHEN HILL
  • NPI Number: 1033866801
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 14D2193071
LAB Type Physician Office
Facility Name CARLE WEST PHYSICIAN GROUP - BLOOMINGTON CONV CARE
Street 3024 E EMPIRE - FIRST FLOOR
City BLOOMINGTON
State IL
ZIP 61704
Phone 309 556-7556
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Physician Office
Lab Director STEPHEN HILL

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