14D2051431 CLIA NUMBER - NORTHSHORE UNIVERSITY HEALTH SYSTEM

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Laboratory Demographics

CLIA Number: 14D2051431

Facility Name: NORTHSHORE UNIVERSITY HEALTH SYSTEM

Facility Address:
GLENBROOK HOSPITAL SPECIALTY SUITE 2150 PFINGSTEN RD, STE 3000
GLENVIEW, IL
ZIP 60025
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Facility Phone Number: 847 663-8034

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1437359189

Taxonomy: 305R00000X - Preferred Provider Organization
A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.

CLIA Record

Field Name	Field Value
CLIA Number	14D2051431
LAB Type	Physician Office
Facility Name	NORTHSHORE UNIVERSITY HEALTH SYSTEM
Street	GLENBROOK HOSPITAL SPECIALTY SUITE 2150 PFINGSTEN RD, STE 3000
City	GLENVIEW
State	IL
ZIP	60025
Phone	847 663-8034
CertificateType	4
CertificateEffectiveDate	12/18/2022
CertificateExpirationDate	12/17/2024
FacilityType	Waiver

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