14D2090277 CLIA NUMBER - RUSH PEDIATRIC UNIV PRIMARY CARE CENTER - POB 940

Laboratory Demographics

  • CLIA Code: 14D2090277
  • Facility Name: RUSH PEDIATRIC UNIV PRIMARY CARE CENTER - POB 940
  • Facility Address: 1725 W HARRISON ST - STE 940
    CHICAGO, IL
    ZIP 60612
  • Facility Phone: 312 563-2340
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARRIE DRAZBA M D
  • NPI Number: 1124076526
  • Taxonomy: 2086S0120X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 14D2090277
LAB Type Physician Office
Facility Name RUSH PEDIATRIC UNIV PRIMARY CARE CENTER - POB 940
Street 1725 W HARRISON ST - STE 940
City CHICAGO
State IL
ZIP 60612
Phone 312 563-2340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2025
Certificate Expiration Date 1/19/2027
Facility Type Physician Office
Lab Director CARRIE DRAZBA M D

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This page was last updated on: 9/29/2025