14D2324652 CLIA NUMBER - DEACONESS IL CLINIC

Laboratory Demographics

  • CLIA Code: 14D2324652
  • Facility Name: DEACONESS IL CLINIC
  • Facility Address: 700 LOGAN COLLEGE DR - J BUILDING
    CARTERVILLE, IL
    ZIP 62918
  • Facility Phone: 618 969-8630
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JODI FOX
  • NPI Number: 1063104206
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2324652
LAB Type Physician Office
Facility Name DEACONESS IL CLINIC
Street 700 LOGAN COLLEGE DR - J BUILDING
City CARTERVILLE
State IL
ZIP 62918
Phone 618 969-8630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/29/2025
Certificate Expiration Date 5/28/2027
Facility Type Physician Office
Lab Director JODI FOX

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