14D2103249 CLIA NUMBER - PCC COMMUNITY WELLNESS CTR - STEINMETZ

Laboratory Demographics

CLIA Number: 14D2103249

Facility Name: PCC COMMUNITY WELLNESS CTR - STEINMETZ

Facility Address:
3030 N MOBILE AVE
CHICAGO, IL
ZIP 60634
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Facility Phone Number: 708 406-3041

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1255701942

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2103249
LAB Type	Federally Qualified Health Center
Facility Name	PCC COMMUNITY WELLNESS CTR - STEINMETZ
Street	3030 N MOBILE AVE
City	CHICAGO
State	IL
ZIP	60634
Phone	708 406-3041
CertificateType	3
CertificateEffectiveDate	10/8/2023
CertificateExpirationDate	10/7/2025
FacilityType	PPMP

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