14D2236474 CLIA NUMBER - DR GAUTAM JHA

Laboratory Demographics

  • CLIA Code: 14D2236474
  • Facility Name: DR GAUTAM JHA
  • Facility Address: 1325 W WHITTAKER - STE D
    SALEM, IL
    ZIP 62881
  • Facility Phone: 618 740-0300
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: GAUTAM JHA
  • NPI Number: 1447314737
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2236474
LAB Type Physician Office
Facility Name DR GAUTAM JHA
Street 1325 W WHITTAKER - STE D
City SALEM
State IL
ZIP 62881
Phone 618 740-0300
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 2/5/2025
Certificate Expiration Date 2/4/2027
Facility Type Physician Office
Lab Director GAUTAM JHA

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