14D2109924 CLIA NUMBER - ADVOCATE CLINIC OAK LAWN 95TH STREET

Laboratory Demographics

CLIA Number: 14D2109924

Facility Name: ADVOCATE CLINIC OAK LAWN 95TH STREET

Facility Address:
4740 WEST 95TH ST
OAK LAWN, IL
ZIP 60453
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Facility Phone Number: 773 295-3101

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619333291

Taxonomy: 282NC2000X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	14D2109924
LAB Type	Physician Office
Facility Name	ADVOCATE CLINIC OAK LAWN 95TH STREET
Street	4740 WEST 95TH ST
City	OAK LAWN
State	IL
ZIP	60453
Phone	773 295-3101
CertificateType	4
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	Waiver

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