14D2026160 CLIA NUMBER - LEGACY MEDICAL CARE INC

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Laboratory Demographics

CLIA Number: 14D2026160

Facility Name: LEGACY MEDICAL CARE INC

Facility Address:
2055 W ARMY TRAIL RD, STE 104
ADDISON, IL
ZIP 60101
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Facility Phone Number: 630 599-5400

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1902355316

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2026160
LAB Type	Physician Office
Facility Name	LEGACY MEDICAL CARE INC
Street	2055 W ARMY TRAIL RD, STE 104
City	ADDISON
State	IL
ZIP	60101
Phone	630 599-5400
CertificateType	3
CertificateEffectiveDate	6/24/2023
CertificateExpirationDate	6/23/2025
FacilityType	PPMP

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