14D0984464 CLIA NUMBER - RUSH SURGICENTER AT THE PROFESSIONAL BLDG

Laboratory Demographics

CLIA Number: 14D0984464

Facility Name: RUSH SURGICENTER AT THE PROFESSIONAL BLDG

Facility Address:
1725 W HARRISON SUITE 556
CHICAGO, IL
ZIP 60612
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Facility Phone Number: 312 563-2889

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1619013455

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0984464
LAB Type	Ambulatory Surgery Center
Facility Name	RUSH SURGICENTER AT THE PROFESSIONAL BLDG
Street	1725 W HARRISON SUITE 556
City	CHICAGO
State	IL
ZIP	60612
Phone	312 563-2889
CertificateType	4
CertificateEffectiveDate	3/22/2023
CertificateExpirationDate	3/21/2025
FacilityType	Waiver

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