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14D2201731 CLIA NUMBER - ICAN CLINIC LLC

Laboratory Demographics

CLIA Number: 14D2201731

Facility Name: ICAN CLINIC LLC

Facility Address:
441 S STATE RTE 157 SUITE 102
EDWARDSVILLE, IL
ZIP 62025
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Facility Phone Number: 618 254-2273

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1992461776

Taxonomy: 208600000X - Surgery
A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.

CLIA Record

Field Name Field Value
CLIA Number 14D2201731
LAB Type Physician Office
Facility Name ICAN CLINIC LLC
Street 441 S STATE RTE 157 SUITE 102
City EDWARDSVILLE
State IL
ZIP 62025
Phone 618 254-2273
CertificateType 4
CertificateEffectiveDate 11/23/2022
CertificateExpirationDate 11/22/2024
FacilityType Waiver

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