14D2026195 CLIA NUMBER - LEGACY MEDICAL CARE INC

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Laboratory Demographics

CLIA Number: 14D2026195

Facility Name: LEGACY MEDICAL CARE INC

Facility Address:
6620 N BARRINGTON RD
HANOVER PARK, IL
ZIP 60133
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Facility Phone Number: 630 736-2903

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1558810960

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2026195
LAB Type	Physician Office
Facility Name	LEGACY MEDICAL CARE INC
Street	6620 N BARRINGTON RD
City	HANOVER PARK
State	IL
ZIP	60133
Phone	630 736-2903
CertificateType	3
CertificateEffectiveDate	6/27/2023
CertificateExpirationDate	6/26/2025
FacilityType	PPMP

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