14D2307968 CLIA NUMBER - HARLEM 122 HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 14D2307968
  • Facility Name: HARLEM 122 HEALTH CLINIC
  • Facility Address: 1 HUSKIE CIRCLE
    MACHESNEY PARK, IL
    ZIP 61115
  • Facility Phone: 802 857-0400
  • Facility Type: Other - ONISTE EMPLOYER HEALTH CT
  • Facility Type: Waiver
  • Lab Director: BRIAN JOHNSON
  • NPI Number: 1346092178
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2307968
LAB Type Other - ONISTE EMPLOYER HEALTH CT
Facility Name HARLEM 122 HEALTH CLINIC
Street 1 HUSKIE CIRCLE
City MACHESNEY PARK
State IL
ZIP 61115
Phone 802 857-0400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2024
Certificate Expiration Date 7/17/2026
Facility Type Other - ONISTE EMPLOYER HEALTH CT
Lab Director BRIAN JOHNSON

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