14D0724414 CLIA NUMBER - LOGAN SQUARE DIALYSIS

Laboratory Demographics

CLIA Number: 14D0724414

Facility Name: LOGAN SQUARE DIALYSIS

Facility Address:
2838 N KIMBALL AVE
CHICAGO, IL
ZIP 60618
Get Directions

Facility Phone Number: 773 276-3699

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1841389830

Taxonomy: 261QP1100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0724414
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LOGAN SQUARE DIALYSIS
Street	2838 N KIMBALL AVE
City	CHICAGO
State	IL
ZIP	60618
Phone	773 276-3699
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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