14D2060117 CLIA NUMBER - OAK STREET HEALTH - PORTAGE PARK CENTER

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Laboratory Demographics

CLIA Number: 14D2060117

Facility Name: OAK STREET HEALTH - PORTAGE PARK CENTER

Facility Address:
4848 W IRVING PARK RD
CHICAGO, IL
ZIP 60641
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Facility Phone Number: 773 724-6200

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144660085

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2060117
LAB Type	Physician Office
Facility Name	OAK STREET HEALTH - PORTAGE PARK CENTER
Street	4848 W IRVING PARK RD
City	CHICAGO
State	IL
ZIP	60641
Phone	773 724-6200
CertificateType	4
CertificateEffectiveDate	6/6/2023
CertificateExpirationDate	6/5/2025
FacilityType	Waiver

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