14D0646704 CLIA NUMBER - PEMBROKE COMMUNITY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 14D0646704
  • Facility Name: PEMBROKE COMMUNITY HEALTH CENTER
  • Facility Address: 3400 S MAIN ST
    HOPKINS PARK, IL
    ZIP 60944
  • Facility Phone: 815 944-5545
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STONEWALL MCCUISTON
  • NPI Number: 1982703005
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0646704
LAB Type Physician Office
Facility Name PEMBROKE COMMUNITY HEALTH CENTER
Street 3400 S MAIN ST
City HOPKINS PARK
State IL
ZIP 60944
Phone 815 944-5545
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2025
Certificate Expiration Date 4/17/2027
Facility Type Physician Office
Lab Director STONEWALL MCCUISTON

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