14D2163241 CLIA NUMBER - CONCENTRA - BEDFORD PARK

Laboratory Demographics

CLIA Number: 14D2163241

Facility Name: CONCENTRA - BEDFORD PARK

Facility Address:
5015 W 65TH ST
BEDFORD PARK, IL
ZIP 60638
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Facility Phone Number: 708 924-8000

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1255862892

Taxonomy: 261QX0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2163241
LAB Type	Physician Office
Facility Name	CONCENTRA - BEDFORD PARK
Street	5015 W 65TH ST
City	BEDFORD PARK
State	IL
ZIP	60638
Phone	708 924-8000
CertificateType	4
CertificateEffectiveDate	3/11/2023
CertificateExpirationDate	3/10/2025
FacilityType	Waiver

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