14D1039164 CLIA NUMBER - BROOKVILLE MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 14D1039164
  • Facility Name: BROOKVILLE MEDICAL CENTER
  • Facility Address: 730 S WEBER RD
    BOLINGBROOK, IL
    ZIP 60490
  • Facility Phone: 630 378-2000
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: VARSHA D. SAMBARE
  • NPI Number: 1780606566
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D1039164
LAB Type Physician Office
Facility Name BROOKVILLE MEDICAL CENTER
Street 730 S WEBER RD
City BOLINGBROOK
State IL
ZIP 60490
Phone 630 378-2000
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/11/2024
Certificate Expiration Date 5/10/2026
Facility Type Physician Office
Lab Director VARSHA D. SAMBARE

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This page was last updated on: 3/20/2025