14D1004066 CLIA NUMBER - UNIVERSAL HEALTHCLINICS SC

Laboratory Demographics

CLIA Number: 14D1004066

Facility Name: UNIVERSAL HEALTHCLINICS SC

Facility Address:
1243 W 79TH ST
CHICAGO, IL
ZIP 60620
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Facility Phone Number: 773 488-0844

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790373702

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1004066
LAB Type	Physician Office
Facility Name	UNIVERSAL HEALTHCLINICS SC
Street	1243 W 79TH ST
City	CHICAGO
State	IL
ZIP	60620
Phone	773 488-0844
CertificateType	4
CertificateEffectiveDate	9/18/2022
CertificateExpirationDate	9/17/2024
FacilityType	Waiver

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