14D2074682 CLIA NUMBER - WEST SIDE DIALYSIS

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Laboratory Demographics

CLIA Number: 14D2074682

Facility Name: WEST SIDE DIALYSIS

Facility Address:
1600 WEST 13TH ST
CHICAGO, IL
ZIP 60608
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Facility Phone Number: 312 243-9286

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1174947204

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2074682
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WEST SIDE DIALYSIS
Street	1600 WEST 13TH ST
City	CHICAGO
State	IL
ZIP	60608
Phone	312 243-9286
CertificateType	4
CertificateEffectiveDate	3/13/2024
CertificateExpirationDate	3/12/2026
FacilityType	Waiver

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