14D2013909 CLIA NUMBER - ACCREDITED AMBULATORY CARE LLC

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Laboratory Demographics

CLIA Number: 14D2013909

Facility Name: ACCREDITED AMBULATORY CARE LLC

Facility Address:
1212 N LA SALLE ST, STE 100
CHICAGO, IL
ZIP 60610
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Facility Phone Number: 312 943-7246

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174837082

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2013909
LAB Type	Physician Office
Facility Name	ACCREDITED AMBULATORY CARE LLC
Street	1212 N LA SALLE ST, STE 100
City	CHICAGO
State	IL
ZIP	60610
Phone	312 943-7246
CertificateType	4
CertificateEffectiveDate	9/27/2022
CertificateExpirationDate	9/26/2024
FacilityType	Waiver

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