14D2167839 CLIA NUMBER - NORTHSHORE IMMEDIATE CARE THE MAIN

Laboratory Demographics

CLIA Number: 14D2167839

Facility Name: NORTHSHORE IMMEDIATE CARE THE MAIN

Facility Address:
524 MAIN ST
EVANSTON, IL
ZIP 60202
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Facility Phone Number: 224 364-2273

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1053432237

Taxonomy: 207ZP0102X - Pathology
A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.

CLIA Record

Field Name	Field Value
CLIA Number	14D2167839
LAB Type	Physician Office
Facility Name	NORTHSHORE IMMEDIATE CARE THE MAIN
Street	524 MAIN ST
City	EVANSTON
State	IL
ZIP	60202
Phone	224 364-2273
CertificateType	4
CertificateEffectiveDate	6/17/2023
CertificateExpirationDate	6/16/2025
FacilityType	Waiver

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