14D1047764 CLIA NUMBER - PARK PRIMARY CARE, LTD

Laboratory Demographics

  • CLIA Code: 14D1047764
  • Facility Name: PARK PRIMARY CARE, LTD
  • Facility Address: 9760 S KEDZIE, STE 2
    EVERGREEN PARK, IL
    ZIP 60805
  • Facility Phone: 708 423-8150
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS JOSEPH
  • NPI Number: 1891984068
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 14D1047764
LAB Type Physician Office
Facility Name PARK PRIMARY CARE, LTD
Street 9760 S KEDZIE, STE 2
City EVERGREEN PARK
State IL
ZIP 60805
Phone 708 423-8150
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Physician Office
Lab Director THOMAS JOSEPH

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This page was last updated on: 9/29/2025