14D2187979 CLIA NUMBER - PHYSICIANS IMMEDIATE CARE

Laboratory Demographics

CLIA Number: 14D2187979

Facility Name: PHYSICIANS IMMEDIATE CARE

Facility Address:
5300 LONG AVE
CHICAGO, IL
ZIP 60638
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Facility Phone Number: 312 300-7400

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1154411072

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2187979
LAB Type	Other - URGENT CARE
Facility Name	PHYSICIANS IMMEDIATE CARE
Street	5300 LONG AVE
City	CHICAGO
State	IL
ZIP	60638
Phone	312 300-7400
CertificateType	4
CertificateEffectiveDate	7/10/2022
CertificateExpirationDate	7/9/2024
FacilityType	Waiver

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