14D2052961 CLIA NUMBER - ASHLAND AVENUE G I, S C

Laboratory Demographics

  • CLIA Code: 14D2052961
  • Facility Name: ASHLAND AVENUE G I, S C
  • Facility Address: 3004 N ASHLAND AVE
    CHICAGO, IL
    ZIP 60657
  • Facility Phone: 773 871-4600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ARTURO OLIVERA M D
  • NPI Number: 1962781252
  • Taxonomy: 261QE0800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2052961
LAB Type Physician Office
Facility Name ASHLAND AVENUE G I, S C
Street 3004 N ASHLAND AVE
City CHICAGO
State IL
ZIP 60657
Phone 773 871-4600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2025
Certificate Expiration Date 1/22/2027
Facility Type Physician Office
Lab Director ARTURO OLIVERA M D

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