14D2205128 CLIA NUMBER - REDBIRD PEDIATRICS

Laboratory Demographics

  • CLIA Code: 14D2205128
  • Facility Name: REDBIRD PEDIATRICS
  • Facility Address: 793 SUNSET BLVD
    O FALLON, IL
    ZIP 62269
  • Facility Phone: 618 668-2473
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVIN M. PONCIROLI
  • NPI Number: 1124634449
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D2205128
LAB Type Physician Office
Facility Name REDBIRD PEDIATRICS
Street 793 SUNSET BLVD
City O FALLON
State IL
ZIP 62269
Phone 618 668-2473
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Physician Office
Lab Director KEVIN M. PONCIROLI

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