14D0869050 CLIA NUMBER - A2CL -ADVOCATE MEDICAL GROUP - ST CHARLES

Laboratory Demographics

CLIA Number: 14D0869050

Facility Name: A2CL -ADVOCATE MEDICAL GROUP - ST CHARLES

Facility Address:
3310 W MAIN STREET, STE 200
SAINT CHARLES, IL
ZIP 60175
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Facility Phone Number: 630 264-8510

Facility Type: Independent

Certificate Type: Waiver

NPI Number: 1902152846

Taxonomy: 261QP2400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0869050
LAB Type	Independent
Facility Name	A2CL -ADVOCATE MEDICAL GROUP - ST CHARLES
Street	3310 W MAIN STREET, STE 200
City	SAINT CHARLES
State	IL
ZIP	60175
Phone	630 264-8510
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