14D1036061 CLIA NUMBER - MT GREENWOOD

Laboratory Demographics

CLIA Number: 14D1036061

Facility Name: MT GREENWOOD

Facility Address:
3401 W 111TH STREET
CHICAGO, IL
ZIP 60655
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Facility Phone Number: (773) 445-0558

Facility Type: END STAGE RENAL DISEASE DIALYSIS

Certificate Type: Waiver

NPI Number: 1982673166

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1036061
LAB Type	END STAGE RENAL DISEASE DIALYSIS
Facility Name	MT GREENWOOD
Street	3401 W 111TH STREET
City	CHICAGO
State	IL
ZIP	60655
Phone	(773) 445-0558

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This page was last updated on: 5/11/2023