14D0962056 CLIA NUMBER - SURGICAL SPECIALTY CENTER LTD

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Laboratory Demographics

CLIA Number: 14D0962056

Facility Name: SURGICAL SPECIALTY CENTER LTD

Facility Address:
6043 W BELMONT AVE
CHICAGO, IL
ZIP 60634
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Facility Phone Number: 773 745-5400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417028879

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	14D0962056
LAB Type	Physician Office
Facility Name	SURGICAL SPECIALTY CENTER LTD
Street	6043 W BELMONT AVE
City	CHICAGO
State	IL
ZIP	60634
Phone	773 745-5400
CertificateType	4
CertificateEffectiveDate	6/23/2023
CertificateExpirationDate	6/22/2025
FacilityType	Waiver

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