14D2043889 CLIA NUMBER - SOUTH LOOP ENDOSCOPY AND WELLNESS CENTER L L C

Laboratory Demographics

  • CLIA Code: 14D2043889
  • Facility Name: SOUTH LOOP ENDOSCOPY AND WELLNESS CENTER L L C
  • Facility Address: 2340 S WABASH AVE
    CHICAGO, IL
    ZIP 60616
  • Facility Phone: 312 808-0248
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DAVID C. CHUA
  • NPI Number: 1285128561
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D2043889
LAB Type Ambulatory Surgery Center
Facility Name SOUTH LOOP ENDOSCOPY AND WELLNESS CENTER L L C
Street 2340 S WABASH AVE
City CHICAGO
State IL
ZIP 60616
Phone 312 808-0248
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/12/2024
Certificate Expiration Date 7/11/2026
Facility Type Ambulatory Surgery Center
Lab Director DAVID C. CHUA

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