14D0725904 CLIA NUMBER - ANDREW A ROTH MD SC

Laboratory Demographics

  • CLIA Code: 14D0725904
  • Facility Name: ANDREW A ROTH MD SC
  • Facility Address: 500 E 22ND ST - STE A
    LOMBARD, IL
    ZIP 60148
  • Facility Phone: 630 932-2055
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ANDREW A. ROTH
  • NPI Number: 1629020532
  • Taxonomy: 2085R0204X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 14D0725904
LAB Type Physician Office
Facility Name ANDREW A ROTH MD SC
Street 500 E 22ND ST - STE A
City LOMBARD
State IL
ZIP 60148
Phone 630 932-2055
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Physician Office
Lab Director ANDREW A. ROTH

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