14D2240670 CLIA NUMBER - SODERSTROM DERMATOLOGY CENTER, SC

Laboratory Demographics

CLIA Number: 14D2240670

Facility Name: SODERSTROM DERMATOLOGY CENTER, SC

Facility Address:
4909 N GLEN PARK PLACE RD
PEORIA, IL
ZIP 61614
Get Directions

Facility Phone Number: 309 690-6012

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1053362343

Taxonomy: 261QA1903X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	10/21/2023
CertificateExpirationDate	10/20/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

This page was last updated on: 4/23/2024