14D2095792 CLIA NUMBER - HYDE PARK SURGICAL CENTER

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Laboratory Demographics

CLIA Number: 14D2095792

Facility Name: HYDE PARK SURGICAL CENTER

Facility Address:
1644 EAST 53RD ST
CHICAGO, IL
ZIP 60615
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Facility Phone Number: (773) 752-6340

Facility Type: AMBULATORY SURGERY CENTER

Certificate Type: Waiver

NPI Number: 1205214103

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2095792
LAB Type	AMBULATORY SURGERY CENTER
Facility Name	HYDE PARK SURGICAL CENTER
Street	1644 EAST 53RD ST
City	CHICAGO
State	IL
ZIP	60615
Phone	(773) 752-6340

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This page was last updated on: 5/11/2023