14D2131914 CLIA NUMBER - PRESENCE LAKESHORE GASTROENTEROLOGY LLC

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Laboratory Demographics

CLIA Number: 14D2131914

Facility Name: PRESENCE LAKESHORE GASTROENTEROLOGY LLC

Facility Address:
150 N RIVER ROAD - SUITE 215
DES PLAINES, IL
ZIP 60016
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Facility Phone Number: 847 787-1099

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1639618036

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2131914
LAB Type	Ambulatory Surgery Center
Facility Name	PRESENCE LAKESHORE GASTROENTEROLOGY LLC
Street	150 N RIVER ROAD - SUITE 215
City	DES PLAINES
State	IL
ZIP	60016
Phone	847 787-1099
CertificateType	4
CertificateEffectiveDate	6/7/2023
CertificateExpirationDate	6/6/2025
FacilityType	Waiver

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