14D1002440 CLIA NUMBER - AMERICAN INDIAN HLTH SERV OF CHGO INC

Laboratory Demographics

CLIA Number: 14D1002440

Facility Name: AMERICAN INDIAN HLTH SERV OF CHGO INC

Facility Address:
4326 W MONTROSE AVE
CHICAGO, IL
ZIP 60641
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Facility Phone Number: 773 883-9100

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1396194692

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1002440
LAB Type	Other
Facility Name	AMERICAN INDIAN HLTH SERV OF CHGO INC
Street	4326 W MONTROSE AVE
City	CHICAGO
State	IL
ZIP	60641
Phone	773 883-9100
CertificateType	4
CertificateEffectiveDate	1/24/2024
CertificateExpirationDate	1/23/2026
FacilityType	Waiver

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