14D2167005 CLIA NUMBER - LEGACY MEDICAL CARE INC

Laboratory Demographics

CLIA Number: 14D2167005

Facility Name: LEGACY MEDICAL CARE INC

Facility Address:
860 SUMMIT ST - STE 231 & STE 241
ELGIN, IL
ZIP 60120
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Facility Phone Number: 224 535-7155

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1750830162

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2167005
LAB Type	Federally Qualified Health Center
Facility Name	LEGACY MEDICAL CARE INC
Street	860 SUMMIT ST - STE 231 & STE 241
City	ELGIN
State	IL
ZIP	60120
Phone	224 535-7155
CertificateType	4
CertificateEffectiveDate	5/30/2023
CertificateExpirationDate	5/29/2025
FacilityType	Waiver

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