14D2077484 CLIA NUMBER - RIVER FOREST PEDIATRICS

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Laboratory Demographics

CLIA Number: 14D2077484

Facility Name: RIVER FOREST PEDIATRICS

Facility Address:
7420 CENTRAL AVE, STE 2040
RIVER FOREST, IL
ZIP 60305
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Facility Phone Number: 708 776-7220

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1083615470

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2077484
LAB Type	Physician Office
Facility Name	RIVER FOREST PEDIATRICS
Street	7420 CENTRAL AVE, STE 2040
City	RIVER FOREST
State	IL
ZIP	60305
Phone	708 776-7220
CertificateType	4
CertificateEffectiveDate	4/6/2024
CertificateExpirationDate	4/5/2026
FacilityType	Waiver

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