14D2254650 CLIA NUMBER - MEDMARK TREATMENT CENTERS SPRINGFIELD SPRINGFIELD TREATMENT CENTER, LLC

Laboratory Demographics

  • CLIA Code: 14D2254650
  • Facility Name: MEDMARK TREATMENT CENTERS SPRINGFIELD SPRINGFIELD TREATMENT CENTER, LLC
  • Facility Address: 1227 S 9TH ST
    SPRINGFIELD, IL
    ZIP 62703
  • Facility Phone: 217 858-4340
  • Facility Type: Other - NARCOTIC TRMT PROGRAM
  • Facility Type: Waiver
  • Lab Director: AUDREY LYNN TANKSLEY
  • NPI Number: 1871132142
  • Taxonomy: 261QM2800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2254650
LAB Type Other - NARCOTIC TRMT PROGRAM
Facility Name MEDMARK TREATMENT CENTERS SPRINGFIELD SPRINGFIELD TREATMENT CENTER, LLC
Street 1227 S 9TH ST
City SPRINGFIELD
State IL
ZIP 62703
Phone 217 858-4340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Other - NARCOTIC TRMT PROGRAM
Lab Director AUDREY LYNN TANKSLEY

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