14D2225919 CLIA NUMBER - SOUTHERN ILLINOIS ASSOCIATES LLC

Laboratory Demographics

  • CLIA Code: 14D2225919
  • Facility Name: SOUTHERN ILLINOIS ASSOCIATES LLC
  • Facility Address: 6805 STATE ROUTE 162 - STE 201
    MARYVILLE, IL
    ZIP 62062
  • Facility Phone: 618 288-5019
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SANJAY NIGAM M D
  • NPI Number: 1962427856
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 14D2225919
LAB Type Physician Office
Facility Name SOUTHERN ILLINOIS ASSOCIATES LLC
Street 6805 STATE ROUTE 162 - STE 201
City MARYVILLE
State IL
ZIP 62062
Phone 618 288-5019
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2025
Certificate Expiration Date 5/24/2027
Facility Type Physician Office
Lab Director SANJAY NIGAM M D

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