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14D0646690 CLIA NUMBER - COLLEGE OF DENTISTRY, DEPT OMFS UNIV OF ILLINOIS AT CHICAGO

Laboratory Demographics

CLIA Number: 14D0646690

Facility Name: COLLEGE OF DENTISTRY, DEPT OMFS UNIV OF ILLINOIS AT CHICAGO

Facility Address:
801 S PAULINA ST, (MC-621, RM 110) DEPARTMENT OF ORAL SURGERY
CHICAGO, IL
ZIP 60612
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Facility Phone Number: 312 355-0209

Facility Type: School/Student Health Service

Certificate Type: Waiver
NPI Number: 1407299001

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name Field Value
CLIA Number 14D0646690
LAB Type School/Student Health Service
Facility Name COLLEGE OF DENTISTRY, DEPT OMFS UNIV OF ILLINOIS AT CHICAGO
Street 801 S PAULINA ST, (MC-621, RM 110) DEPARTMENT OF ORAL SURGERY
City CHICAGO
State IL
ZIP 60612
Phone 312 355-0209
CertificateType 4
CertificateEffectiveDate 3/4/2023
CertificateExpirationDate 3/3/2025
FacilityType Waiver

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