01D0692716 CLIA NUMBER - JEFFERSON PEDIATRICS PC

Laboratory Demographics

  • CLIA Code: 01D0692716
  • Facility Name: JEFFERSON PEDIATRICS PC
  • Facility Address: 3919 W JEFFERSON BLVD STE 1
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 436-7722
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GIRIDHAR R. VEERULA
  • NPI Number: 1134542855
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 01D0692716
LAB Type Physician Office
Facility Name JEFFERSON PEDIATRICS PC
Street 3919 W JEFFERSON BLVD STE 1
City FORT WAYNE
State IN
ZIP 46804
Phone 260 436-7722
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2023
Certificate Expiration Date 10/13/2025
Facility Type Physician Office
Lab Director GIRIDHAR R. VEERULA

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This page was last updated on: 3/20/2025