14D0913083 CLIA NUMBER - JERRY JENSEN D O

Laboratory Demographics

  • CLIA Code: 14D0913083
  • Facility Name: JERRY JENSEN D O
  • Facility Address: 15525 SOUTH PARK #113
    SOUTH HOLLAND, IL
    ZIP 60473
  • Facility Phone: 708 331-5100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JERRY L. JENSEN D O
  • NPI Number: 1558372615
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D0913083
LAB Type Physician Office
Facility Name JERRY JENSEN D O
Street 15525 SOUTH PARK #113
City SOUTH HOLLAND
State IL
ZIP 60473
Phone 708 331-5100
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 3/20/2024
Certificate Expiration Date 3/19/2026
Facility Type Physician Office
Lab Director JERRY L. JENSEN D O

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