Organization
COMPREHENSIVE HEMOSTASIS AND THROMBOSIS INSTITUTE
Active
Other names
Comprehensive Hemostasis and Thrombosis Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY L DAVIS (EXECUTIVE DIRECTOR)
(309) 688-1345
Entity
Organization
Contact information
Practice address
4727 N SHERIDAN RD, PEORIA, IL 61614-5925
(309) 688-1345
(309) 688-0917
Mailing address
4727 N SHERIDAN RD, PEORIA, IL 61614-5925
(309) 688-1345
(309) 688-0917
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
14D0982678 CLIA
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7230099
BCBS OF IL
IL
01
—
P00115815
RAILROAD MEDICARE
—
Enumeration date
09/23/2005
Last updated
08/08/2008
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