14D2294500 CLIA NUMBER - CENTRAL ILLINOIS PREVENTIVE SERVICES

Laboratory Demographics

  • CLIA Code: 14D2294500
  • Facility Name: CENTRAL ILLINOIS PREVENTIVE SERVICES
  • Facility Address: 1603 TULLAMORE AVE - UNIT A
    BLOOMINGTON, IL
    ZIP 61704
  • Facility Phone: (309) 808-6407
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LARRY OVERCASH
  • NPI Number: 1144003633
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2294500
LAB Type Physician Office
Facility Name CENTRAL ILLINOIS PREVENTIVE SERVICES
Street 1603 TULLAMORE AVE - UNIT A
City BLOOMINGTON
State IL
ZIP 61704
Phone 3098086407
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2025
Certificate Expiration Date 11/27/2027
Facility Type Physician Office
Lab Director LARRY OVERCASH

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This page was last updated on: 5/18/2026