14D2238216 CLIA NUMBER - GOTTLIEB MEMORIAL HOSPITAL LAB - WAIVED TESTING

Laboratory Demographics

  • CLIA Code: 14D2238216
  • Facility Name: GOTTLIEB MEMORIAL HOSPITAL LAB - WAIVED TESTING
  • Facility Address: 701 W NORTH AVE
    MELROSE PARK, IL
    ZIP 60160
  • Facility Phone: 708 538-4906
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: PHILLIP DECHRISTOPHER
  • NPI Number: 1003832767
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 14D2238216
LAB Type Hospital
Facility Name GOTTLIEB MEMORIAL HOSPITAL LAB - WAIVED TESTING
Street 701 W NORTH AVE
City MELROSE PARK
State IL
ZIP 60160
Phone 708 538-4906
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2023
Certificate Expiration Date 9/30/2025
Facility Type Hospital
Lab Director PHILLIP DECHRISTOPHER

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This page was last updated on: 9/29/2025