14D1080638 CLIA NUMBER - N M G - CRYSTAL LAKE IMMEDIATE CARE CENTER

Laboratory Demographics

  • CLIA Code: 14D1080638
  • Facility Name: N M G - CRYSTAL LAKE IMMEDIATE CARE CENTER
  • Facility Address: 360 STATION DR - STE 300A
    CRYSTAL LAKE, IL
    ZIP 60014
  • Facility Phone: 847 802-7154
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATILDA ROSANWO
  • NPI Number: 1871702985
  • Taxonomy: 261QD0000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1080638
LAB Type Physician Office
Facility Name N M G - CRYSTAL LAKE IMMEDIATE CARE CENTER
Street 360 STATION DR - STE 300A
City CRYSTAL LAKE
State IL
ZIP 60014
Phone 847 802-7154
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2024
Certificate Expiration Date 5/30/2026
Facility Type Physician Office
Lab Director MATILDA ROSANWO

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