14D1005753 CLIA NUMBER - SUMMIT MEDICAL CENTER

Laboratory Demographics

CLIA Number: 14D1005753

Facility Name: SUMMIT MEDICAL CENTER

Facility Address:
6252 SOUTH ARCHER ROAD
SUMMIT, IL
ZIP 60501
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Facility Phone Number: 708 496-9549

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1679744643

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1005753
LAB Type	Physician Office
Facility Name	SUMMIT MEDICAL CENTER
Street	6252 SOUTH ARCHER ROAD
City	SUMMIT
State	IL
ZIP	60501
Phone	708 496-9549
CertificateType	4
CertificateEffectiveDate	10/30/2022
CertificateExpirationDate	10/29/2024
FacilityType	Waiver

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