14D1054952 CLIA NUMBER - WILLOW SPRINGS SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 14D1054952
  • Facility Name: WILLOW SPRINGS SURGERY CENTER, LLC
  • Facility Address: 2055 ARMY TRAIL RD - STE 110N
    ADDISON, IL
    ZIP 60101
  • Facility Phone: 773 284-9247
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: GAUTUM BHANUSHALI
  • NPI Number: 1467429233
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1054952
LAB Type Ambulatory Surgery Center
Facility Name WILLOW SPRINGS SURGERY CENTER, LLC
Street 2055 ARMY TRAIL RD - STE 110N
City ADDISON
State IL
ZIP 60101
Phone 773 284-9247
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/6/2024
Certificate Expiration Date 6/5/2026
Facility Type Ambulatory Surgery Center
Lab Director GAUTUM BHANUSHALI

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