14D0706274 CLIA NUMBER - WINFIELD MOODY HEALTH CENTER NEAR NORTH HEALTH SERVICE CORPORATION

Laboratory Demographics

CLIA Number: 14D0706274

Facility Name: WINFIELD MOODY HEALTH CENTER NEAR NORTH HEALTH SERVICE CORPORATION

Facility Address:
1276 N CLYBOURN
CHICAGO, IL
ZIP 60610
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Facility Phone Number: 312 337-1076

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1821079088

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0706274
LAB Type	Community Clinic
Facility Name	WINFIELD MOODY HEALTH CENTER NEAR NORTH HEALTH SERVICE CORPORATION
Street	1276 N CLYBOURN
City	CHICAGO
State	IL
ZIP	60610
Phone	312 337-1076
CertificateType	3
CertificateEffectiveDate	9/30/2022
CertificateExpirationDate	9/29/2024
FacilityType	PPMP

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