14D2055221 CLIA NUMBER - FRESENIUS MEDICAL CARE LOGAN SQUARE

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Laboratory Demographics

CLIA Number: 14D2055221

Facility Name: FRESENIUS MEDICAL CARE LOGAN SQUARE

Facility Address:
2721 N SPAULDING AVE
CHICAGO, IL
ZIP 60647
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Facility Phone Number: 773 292-2971

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1457690604

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2055221
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS MEDICAL CARE LOGAN SQUARE
Street	2721 N SPAULDING AVE
City	CHICAGO
State	IL
ZIP	60647
Phone	773 292-2971
CertificateType	4
CertificateEffectiveDate	3/7/2023
CertificateExpirationDate	3/6/2025
FacilityType	Waiver

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