14D0721179 CLIA NUMBER - HERITAGE HEALTH - PANA

Laboratory Demographics

  • CLIA Code: 14D0721179
  • Facility Name: HERITAGE HEALTH - PANA
  • Facility Address: 1000 E 6TH STREET RD
    PANA, IL
    ZIP 62557
  • Facility Phone: 217 562-2174
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: CARL PORTZ
  • NPI Number: 1629312335
  • Taxonomy: 332BX2000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 14D0721179
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name HERITAGE HEALTH - PANA
Street 1000 E 6TH STREET RD
City PANA
State IL
ZIP 62557
Phone 217 562-2174
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director CARL PORTZ

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