14D1052566 CLIA NUMBER - P C C SOUTH FAMILY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 14D1052566
  • Facility Name: P C C SOUTH FAMILY HEALTH CENTER
  • Facility Address: 6201 W ROOSEVELT RD
    BERWYN, IL
    ZIP 60402
  • Facility Phone: 708 386-0845
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: REBECCA DE HOEK MD
  • NPI Number: 1174549786
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1052566
LAB Type Federally Qualified Health Center
Facility Name P C C SOUTH FAMILY HEALTH CENTER
Street 6201 W ROOSEVELT RD
City BERWYN
State IL
ZIP 60402
Phone 708 386-0845
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 1/8/2025
Certificate Expiration Date 1/7/2027
Facility Type Federally Qualified Health Center
Lab Director REBECCA DE HOEK MD

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