14D1025123 CLIA NUMBER - CENTER FOR FAMILY AND GERIATRIC MEDICINE SC

Laboratory Demographics

CLIA Number: 14D1025123

Facility Name: CENTER FOR FAMILY AND GERIATRIC MEDICINE SC

Facility Address:
1100 W CENTRAL RD STE 301
ARLINGTON HEIGHTS, IL
ZIP 60005
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Facility Phone Number: 847 439-2200

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1033224613

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1025123
LAB Type	Physician Office
Facility Name	CENTER FOR FAMILY AND GERIATRIC MEDICINE SC
Street	1100 W CENTRAL RD STE 301
City	ARLINGTON HEIGHTS
State	IL
ZIP	60005
Phone	847 439-2200
CertificateType	4
CertificateEffectiveDate	4/29/2024
CertificateExpirationDate	4/28/2026
FacilityType	Waiver

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