14D2138324 CLIA NUMBER - PRAIRIE GLEN PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 14D2138324
  • Facility Name: PRAIRIE GLEN PRIMARY CARE
  • Facility Address: 15505 E 127TH STREET SUITE 100
    LEMONT, IL
    ZIP 60439
  • Facility Phone: 630 257-5400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUSHMA NAGABHAIRVA MD
  • NPI Number: 1851458699
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2138324
LAB Type Physician Office
Facility Name PRAIRIE GLEN PRIMARY CARE
Street 15505 E 127TH STREET SUITE 100
City LEMONT
State IL
ZIP 60439
Phone 630 257-5400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2025
Certificate Expiration Date 10/15/2027
Facility Type Physician Office
Lab Director SUSHMA NAGABHAIRVA MD

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