14D0929159 CLIA NUMBER - CONCENTRA - CHICAGO MIDWAY

Laboratory Demographics

CLIA Number: 14D0929159

Facility Name: CONCENTRA - CHICAGO MIDWAY

Facility Address:
6500 WEST 65TH ST
CHICAGO, IL
ZIP 60638
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Facility Phone Number: 708 496-1515

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144751785

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0929159
LAB Type	Physician Office
Facility Name	CONCENTRA - CHICAGO MIDWAY
Street	6500 WEST 65TH ST
City	CHICAGO
State	IL
ZIP	60638
Phone	708 496-1515
CertificateType	4
CertificateEffectiveDate	6/6/2023
CertificateExpirationDate	6/5/2025
FacilityType	Waiver

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