14D1003961 CLIA NUMBER - CONCENTRA - WEST LOOP

Laboratory Demographics

CLIA Number: 14D1003961

Facility Name: CONCENTRA - WEST LOOP

Facility Address:
1230 W LAKE ST
CHICAGO, IL
ZIP 60607
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Facility Phone Number: 312 666-0028

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992146286

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1003961
LAB Type	Physician Office
Facility Name	CONCENTRA - WEST LOOP
Street	1230 W LAKE ST
City	CHICAGO
State	IL
ZIP	60607
Phone	312 666-0028
CertificateType	4
CertificateEffectiveDate	9/16/2022
CertificateExpirationDate	9/15/2024
FacilityType	Waiver

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