14D2089265 CLIA NUMBER - GOMEZ MEDICAL GROUP

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Laboratory Demographics

CLIA Number: 14D2089265

Facility Name: GOMEZ MEDICAL GROUP

Facility Address:
1600 N RANDALL RD #115
ELGIN, IL
ZIP 60123
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Facility Phone Number: 224 856-2300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1164823779

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2089265
LAB Type	Physician Office
Facility Name	GOMEZ MEDICAL GROUP
Street	1600 N RANDALL RD #115
City	ELGIN
State	IL
ZIP	60123
Phone	224 856-2300
CertificateType	4
CertificateEffectiveDate	12/23/2022
CertificateExpirationDate	12/22/2024
FacilityType	Waiver

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