14D0424859 CLIA NUMBER - RUDYARD SMITH M D S C

Laboratory Demographics

  • CLIA Code: 14D0424859
  • Facility Name: RUDYARD SMITH M D S C
  • Facility Address: 3510 W 79TH ST
    CHICAGO, IL
    ZIP 60652
  • Facility Phone: 773 434-0827
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUDYARD U. SMITH M D
  • NPI Number: 1295784031
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0424859
LAB Type Physician Office
Facility Name RUDYARD SMITH M D S C
Street 3510 W 79TH ST
City CHICAGO
State IL
ZIP 60652
Phone 773 434-0827
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2024
Certificate Expiration Date 10/22/2026
Facility Type Physician Office
Lab Director RUDYARD U. SMITH M D

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