14D1092221 CLIA NUMBER - LINCOLN MEDICAL CENTER P C

Laboratory Demographics

CLIA Number: 14D1092221

Facility Name: LINCOLN MEDICAL CENTER P C

Facility Address:
5106 N LINCOLN AVE
CHICAGO, IL
ZIP 60625
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Facility Phone Number: 773 907-8255

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1396916151

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D1092221
LAB Type	Physician Office
Facility Name	LINCOLN MEDICAL CENTER P C
Street	5106 N LINCOLN AVE
City	CHICAGO
State	IL
ZIP	60625
Phone	773 907-8255
CertificateType	4
CertificateEffectiveDate	11/20/2022
CertificateExpirationDate	11/19/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024