14D2326747 CLIA NUMBER - GREENE COUNTY RURAL HEALTH CLINIC

Laboratory Demographics

  • CLIA Code: 14D2326747
  • Facility Name: GREENE COUNTY RURAL HEALTH CLINIC
  • Facility Address: 727 9TH ST
    CARROLLTON, IL
    ZIP 62016
  • Facility Phone: 217 942-6612
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: RENAN MAPUE
  • NPI Number: 1366535304
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2326747
LAB Type Rural Health Clinic
Facility Name GREENE COUNTY RURAL HEALTH CLINIC
Street 727 9TH ST
City CARROLLTON
State IL
ZIP 62016
Phone 217 942-6612
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/9/2025
Certificate Expiration Date 7/8/2027
Facility Type Rural Health Clinic
Lab Director RENAN MAPUE

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