14D2147698 CLIA NUMBER - GEORGE N ATIA M D S C

Laboratory Demographics

CLIA Number: 14D2147698

Facility Name: GEORGE N ATIA M D S C

Facility Address:
5744 N BROADWAY ST
CHICAGO, IL
ZIP 60660
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Facility Phone Number: 312 335-0180

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1598238529

Taxonomy: 101YP2500X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	14D2147698
LAB Type	Ambulatory Surgery Center
Facility Name	GEORGE N ATIA M D S C
Street	5744 N BROADWAY ST
City	CHICAGO
State	IL
ZIP	60660
Phone	312 335-0180
CertificateType	4
CertificateEffectiveDate	4/24/2024
CertificateExpirationDate	4/23/2026
FacilityType	Waiver

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