14D0895696 CLIA NUMBER - ADVANCED HEART GROUP SC

Laboratory Demographics

  • CLIA Code: 14D0895696
  • Facility Name: ADVANCED HEART GROUP SC
  • Facility Address: 15255 S HARLEM AVE - BLDG B
    ORLAND PARK, IL
    ZIP 60462
  • Facility Phone: 708 429-3300
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GANAPATHI MD GOTTUMUKKALA
  • NPI Number: 1861956849
  • Taxonomy: 2084N0400X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 14D0895696
LAB Type Physician Office
Facility Name ADVANCED HEART GROUP SC
Street 15255 S HARLEM AVE - BLDG B
City ORLAND PARK
State IL
ZIP 60462
Phone 708 429-3300
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 4/19/2024
Certificate Expiration Date 4/18/2026
Facility Type Physician Office
Lab Director GANAPATHI MD GOTTUMUKKALA

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