14D0855629 CLIA NUMBER - PCC COMMUNITY WELLNESS CENTER LAKE STREET FAMILY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 14D0855629
  • Facility Name: PCC COMMUNITY WELLNESS CENTER LAKE STREET FAMILY HEALTH CENTER
  • Facility Address: 14 W LAKE STREET
    OAK PARK, IL
    ZIP 60302
  • Facility Phone: 708 383-0113
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: DINA ZISSIMOPOULOS APN
  • NPI Number: 1871516799
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0855629
LAB Type Community Clinic
Facility Name PCC COMMUNITY WELLNESS CENTER LAKE STREET FAMILY HEALTH CENTER
Street 14 W LAKE STREET
City OAK PARK
State IL
ZIP 60302
Phone 708 383-0113
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/31/2024
Certificate Expiration Date 1/30/2026
Facility Type Community Clinic
Lab Director DINA ZISSIMOPOULOS APN

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This page was last updated on: 9/29/2025