14D2228128 CLIA NUMBER - CHRISTIE CLINIC BLOOMINGTON SUTIE C

Laboratory Demographics

  • CLIA Code: 14D2228128
  • Facility Name: CHRISTIE CLINIC BLOOMINGTON SUTIE C
  • Facility Address: 2502 E EMPIRE - STE C
    BLOOMINGTON, IL
    ZIP 61704
  • Facility Phone: 217 366-1281
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIEL WOOLDRIDGE
  • NPI Number: 1194391078
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 14D2228128
LAB Type Physician Office
Facility Name CHRISTIE CLINIC BLOOMINGTON SUTIE C
Street 2502 E EMPIRE - STE C
City BLOOMINGTON
State IL
ZIP 61704
Phone 217 366-1281
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/22/2025
Certificate Expiration Date 6/21/2027
Facility Type Physician Office
Lab Director DANIEL WOOLDRIDGE

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