14D1079152 CLIA NUMBER - PCC WEST TOWN FAMILY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 14D1079152
  • Facility Name: PCC WEST TOWN FAMILY HEALTH CENTER
  • Facility Address: 2434 W DIVISION STREET
    CHICAGO, IL
    ZIP 60622
  • Facility Phone: 773 584-4178
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JACOB M. SMITH M D
  • NPI Number: 1164628012
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1079152
LAB Type Physician Office
Facility Name PCC WEST TOWN FAMILY HEALTH CENTER
Street 2434 W DIVISION STREET
City CHICAGO
State IL
ZIP 60622
Phone 773 584-4178
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 Physician Office
Lab Director JACOB M. SMITH M D

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