14D2125094 CLIA NUMBER - HOLY CROSS HOSPITAL PROVIDERS

Laboratory Demographics

  • CLIA Code: 14D2125094
  • Facility Name: HOLY CROSS HOSPITAL PROVIDERS
  • Facility Address: 2701 WEST 68TH ST
    CHICAGO, IL
    ZIP 60629
  • Facility Phone: 773 884-4036
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Microscopy
  • Lab Director: FERNANDO ORELLANA MD
  • NPI Number: 1104242718
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2125094
LAB Type Ancillary Testing Site in Health Care Center
Facility Name HOLY CROSS HOSPITAL PROVIDERS
Street 2701 WEST 68TH ST
City CHICAGO
State IL
ZIP 60629
Phone 773 884-4036
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 1/31/2025
Certificate Expiration Date 1/30/2027
Facility Type Ancillary Testing Site in Health Care Center
Lab Director FERNANDO ORELLANA MD

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