14D0706197 CLIA NUMBER - CENTER STREET MEDICAL S C

Laboratory Demographics

CLIA Number: 14D0706197

Facility Name: CENTER STREET MEDICAL S C

Facility Address:
103 HAVEN RD, STE 2
ELMHURST, IL
ZIP 60126
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Facility Phone Number: 630 595-9988

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1114119245

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0706197
LAB Type	Physician Office
Facility Name	CENTER STREET MEDICAL S C
Street	103 HAVEN RD, STE 2
City	ELMHURST
State	IL
ZIP	60126
Phone	630 595-9988
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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