Provider Demographics
NPI:1790274678
Name:HERITAGE LABS, INC.
Entity Type:Organization
Organization Name:HERITAGE LABS, INC.
Other - Org Name:ION DIAGNOSTICS LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NAMEER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMINAIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-327-7800
Mailing Address - Street 1:30600 TELEGRAPH RD STE 1375
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4589
Mailing Address - Country:US
Mailing Address - Phone:248-535-8088
Mailing Address - Fax:877-466-6399
Practice Address - Street 1:1883 HICKS RD STE C
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-1255
Practice Address - Country:US
Practice Address - Phone:616-327-7800
Practice Address - Fax:877-466-6399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-06
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D2258031OtherCLIA IDENTIFICATION NUMBER