14D0427071 CLIA NUMBER - PRIMECARE NORTHWEST

Laboratory Demographics

CLIA Number: 14D0427071

Facility Name: PRIMECARE NORTHWEST

Facility Address:
1649 N PULASKI AVE
CHICAGO, IL
ZIP 60649
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Facility Phone Number: 773 278-6868

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1730235870

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0427071
LAB Type	Federally Qualified Health Center
Facility Name	PRIMECARE NORTHWEST
Street	1649 N PULASKI AVE
City	CHICAGO
State	IL
ZIP	60649
Phone	773 278-6868
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024