14D2110672 CLIA NUMBER - INNER CITY MUSLIM ACTION NETWORK

Laboratory Demographics

CLIA Number: 14D2110672

Facility Name: INNER CITY MUSLIM ACTION NETWORK

Facility Address:
2744 W 63RD ST
CHICAGO, IL
ZIP 60629
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Facility Phone Number: 773 434-4626

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1437672433

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2110672
LAB Type	Community Clinic
Facility Name	INNER CITY MUSLIM ACTION NETWORK
Street	2744 W 63RD ST
City	CHICAGO
State	IL
ZIP	60629
Phone	773 434-4626
CertificateType	4
CertificateEffectiveDate	3/22/2024
CertificateExpirationDate	3/21/2026
FacilityType	Waiver

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