14D2121117 CLIA NUMBER - PALOS HOSPITAL ORLAND PARK IMAGING & DIAGNOSTICS

Laboratory Demographics

  • CLIA Code: 14D2121117
  • Facility Name: PALOS HOSPITAL ORLAND PARK IMAGING & DIAGNOSTICS
  • Facility Address: 15300 WEST AVE - BLDG B - STE 100
    ORLAND PARK, IL
    ZIP 60462
  • Facility Phone: 708 923-5588
  • Facility Type: Other - IMAGING DIAGNOSTIC LAB
  • Facility Type: Waiver
  • Lab Director: JON RANDAL JESTER
  • NPI Number: 1417305350
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 14D2121117
LAB Type Other - IMAGING DIAGNOSTIC LAB
Facility Name PALOS HOSPITAL ORLAND PARK IMAGING & DIAGNOSTICS
Street 15300 WEST AVE - BLDG B - STE 100
City ORLAND PARK
State IL
ZIP 60462
Phone 708 923-5588
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Other - IMAGING DIAGNOSTIC LAB
Lab Director JON RANDAL JESTER

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