14D2240670 CLIA NUMBER - SODERSTROM DERMATOLOGY CENTER, SC

Laboratory Demographics

  • CLIA Code: 14D2240670
  • Facility Name: SODERSTROM DERMATOLOGY CENTER, SC
  • Facility Address: 4909 N GLEN PARK PLACE RD
    PEORIA, IL
    ZIP 61614
  • Facility Phone: 309 690-6012
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JAMES M. JEFFRIES
  • NPI Number: 1053362343
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2240670
LAB Type Ambulatory Surgery Center
Facility Name SODERSTROM DERMATOLOGY CENTER, SC
Street 4909 N GLEN PARK PLACE RD
City PEORIA
State IL
ZIP 61614
Phone 309 690-6012
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2023
Certificate Expiration Date 10/20/2025
Facility Type Ambulatory Surgery Center
Lab Director JAMES M. JEFFRIES

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