14D2040456 CLIA NUMBER - MIDWEST ORTHOPAEDICS RUSH LLC ADVANCE IMAGING

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Laboratory Demographics

CLIA Number: 14D2040456

Facility Name: MIDWEST ORTHOPAEDICS RUSH LLC ADVANCE IMAGING

Facility Address:
1611 W HARRISON STE 105
CHICAGO, IL
ZIP 60612
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Facility Phone Number: 312 432-2570

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1356678619

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	14D2040456
LAB Type	Physician Office
Facility Name	MIDWEST ORTHOPAEDICS RUSH LLC ADVANCE IMAGING
Street	1611 W HARRISON STE 105
City	CHICAGO
State	IL
ZIP	60612
Phone	312 432-2570
CertificateType	4
CertificateEffectiveDate	5/1/2024
CertificateExpirationDate	4/30/2026
FacilityType	Waiver

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