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14D0967603 CLIA NUMBER - RUSH PEDIATRIC PRIMARY CARE CENTER

Laboratory Demographics

CLIA Number: 14D0967603

Facility Name: RUSH PEDIATRIC PRIMARY CARE CENTER

Facility Address:
1645 W JACKSON SUITE 200
CHICAGO, IL
ZIP 60612
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Facility Phone Number: 312 942-2200

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1871560961

Taxonomy: 208000000X - Pediatrics
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

CLIA Record

Field Name Field Value
CLIA Number 14D0967603
LAB Type Physician Office
Facility Name RUSH PEDIATRIC PRIMARY CARE CENTER
Street 1645 W JACKSON SUITE 200
City CHICAGO
State IL
ZIP 60612
Phone 312 942-2200
CertificateType 4
CertificateEffectiveDate 11/17/2023
CertificateExpirationDate 11/16/2025
FacilityType Waiver

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