14D2155699 CLIA NUMBER - ANTI AGING SURGICAL CENTER

Laboratory Demographics

CLIA Number: 14D2155699

Facility Name: ANTI AGING SURGICAL CENTER

Facility Address:
3918 W 63RD ST
CHICAGO, IL
ZIP 60629
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Facility Phone Number: 773 284-9660

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1245466192

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2155699
LAB Type	Ambulatory Surgery Center
Facility Name	ANTI AGING SURGICAL CENTER
Street	3918 W 63RD ST
City	CHICAGO
State	IL
ZIP	60629
Phone	773 284-9660
CertificateType	4
CertificateEffectiveDate	10/3/2022
CertificateExpirationDate	10/2/2024
FacilityType	Waiver

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