14D0665170 CLIA NUMBER - WESTERN DIVERSEY SURGICAL CENTER

Laboratory Demographics

CLIA Number: 14D0665170

Facility Name: WESTERN DIVERSEY SURGICAL CENTER

Facility Address:
2744 N WESTERN AVE
CHICAGO, IL
ZIP 60647
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Facility Phone Number: 773 772-7726

Facility Type: Ambulatory Surgery Center

Certificate Type: Accreditation

NPI Number: 1265583934

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0665170
LAB Type	Ambulatory Surgery Center
Facility Name	WESTERN DIVERSEY SURGICAL CENTER
Street	2744 N WESTERN AVE
City	CHICAGO
State	IL
ZIP	60647
Phone	773 772-7726
CertificateType	1
CertificateEffectiveDate	12/23/2023
CertificateExpirationDate	12/22/2025
FacilityType	Accreditation

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