14D2039676 CLIA NUMBER - ELGIN GASTROENTEROLOGY ENDOSCOPY CENTER LLC

Laboratory Demographics

  • CLIA Code: 14D2039676
  • Facility Name: ELGIN GASTROENTEROLOGY ENDOSCOPY CENTER LLC
  • Facility Address: 745 FLETCHER DR STE 201
    ELGIN, IL
    ZIP 60123
  • Facility Phone: 847 888-5311
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SONIA SHAILESH GODAMBE
  • NPI Number: 1992875454
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2039676
LAB Type Ambulatory Surgery Center
Facility Name ELGIN GASTROENTEROLOGY ENDOSCOPY CENTER LLC
Street 745 FLETCHER DR STE 201
City ELGIN
State IL
ZIP 60123
Phone 847 888-5311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2024
Certificate Expiration Date 4/15/2026
Facility Type Ambulatory Surgery Center
Lab Director SONIA SHAILESH GODAMBE

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