14D2157267 CLIA NUMBER - MOUNT SINAI HOSPITAL SPASTICITY CLINIC

Laboratory Demographics

CLIA Number: 14D2157267

Facility Name: MOUNT SINAI HOSPITAL SPASTICITY CLINIC

Facility Address:
1401 S CALIFORNIA AVE - 2ND FLR (CLINIC 2 NORTH)
CHICAGO, IL
ZIP 60608
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Facility Phone Number: 773 565-3250

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104858125

Taxonomy: 282NR1301X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	14D2157267
LAB Type	Physician Office
Facility Name	MOUNT SINAI HOSPITAL SPASTICITY CLINIC
Street	1401 S CALIFORNIA AVE - 2ND FLR (CLINIC 2 NORTH)
City	CHICAGO
State	IL
ZIP	60608
Phone	773 565-3250
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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