14D2248296 CLIA NUMBER - PREMIUM PRACTITIONERS PLUS INC

Laboratory Demographics

  • CLIA Code: 14D2248296
  • Facility Name: PREMIUM PRACTITIONERS PLUS INC
  • Facility Address: 19801 GOVERNORS HIGHWAY - STE 140
    FLOSSMOOR, IL
    ZIP 60422
  • Facility Phone: 708 600-0965
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TALIA THOMPSON-JONES
  • NPI Number: 1194296533
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2248296
LAB Type Physician Office
Facility Name PREMIUM PRACTITIONERS PLUS INC
Street 19801 GOVERNORS HIGHWAY - STE 140
City FLOSSMOOR
State IL
ZIP 60422
Phone 708 600-0965
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/12/2024
Certificate Expiration Date 1/11/2026
Facility Type Physician Office
Lab Director TALIA THOMPSON-JONES

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