14D0716020 CLIA NUMBER - FRESENIUS MEDICAL CARE BRIDGEPORT

Laboratory Demographics

CLIA Number: 14D0716020

Facility Name: FRESENIUS MEDICAL CARE BRIDGEPORT

Facility Address:
825 WEST 35TH STREET
CHICAGO, IL
ZIP 60609
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Facility Phone Number: 773 890-4330

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1114350485

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0716020
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS MEDICAL CARE BRIDGEPORT
Street	825 WEST 35TH STREET
City	CHICAGO
State	IL
ZIP	60609
Phone	773 890-4330
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