14D2133911 CLIA NUMBER - PREMIUM HEALTH CARE PC

Laboratory Demographics

  • CLIA Code: 14D2133911
  • Facility Name: PREMIUM HEALTH CARE PC
  • Facility Address: 16003 EXECUTIVE DR
    CREST HILL, IL
    ZIP 60403
  • Facility Phone: 815 280-5796
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSE RIVERA
  • NPI Number: 1386184448
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 14D2133911
LAB Type Physician Office
Facility Name PREMIUM HEALTH CARE PC
Street 16003 EXECUTIVE DR
City CREST HILL
State IL
ZIP 60403
Phone 815 280-5796
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2024
Certificate Expiration Date 4/5/2026
Facility Type Physician Office
Lab Director JOSE RIVERA

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