14D0916670 CLIA NUMBER - AUSTIN FAMILY HEALTH CENTER (LAB) P C C COMMUNITY WELLNESS CENTER

Laboratory Demographics

CLIA Number: 14D0916670

Facility Name: AUSTIN FAMILY HEALTH CENTER (LAB) P C C COMMUNITY WELLNESS CENTER

Facility Address:
5425 W LAKE ST
CHICAGO, IL
ZIP 60644
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Facility Phone Number: 773 378-3347

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1609892223

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0916670
LAB Type	Community Clinic
Facility Name	AUSTIN FAMILY HEALTH CENTER (LAB) P C C COMMUNITY WELLNESS CENTER
Street	5425 W LAKE ST
City	CHICAGO
State	IL
ZIP	60644
Phone	773 378-3347
CertificateType	3
CertificateEffectiveDate	6/27/2022
CertificateExpirationDate	6/26/2024
FacilityType	PPMP

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