14D1004624 CLIA NUMBER - SOUTH PARK PEDIATRICS

Laboratory Demographics

  • CLIA Code: 14D1004624
  • Facility Name: SOUTH PARK PEDIATRICS
  • Facility Address: 15821 SOUTH PARK
    SOUTH HOLLAND, IL
    ZIP 60473
  • Facility Phone: 708 225-0200
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: WENDELL A. WHEELER
  • NPI Number: 1346424876
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 14D1004624
LAB Type Physician Office
Facility Name SOUTH PARK PEDIATRICS
Street 15821 SOUTH PARK
City SOUTH HOLLAND
State IL
ZIP 60473
Phone 708 225-0200
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 10/2/2024
Certificate Expiration Date 10/1/2026
Facility Type Physician Office
Lab Director WENDELL A. WHEELER

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