15D0356479 CLIA NUMBER - SAINT JOSEPH MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 15D0356479
  • Facility Name: SAINT JOSEPH MEDICAL GROUP
  • Facility Address: 114 N WASHINGTON ST
    BOURBON, IN
    ZIP 46504
  • Facility Phone: 574 335-7850
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES HIGGS COULTHARD
  • NPI Number: 1033274071
  • Taxonomy: 1223G0001X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 15D0356479
LAB Type Physician Office
Facility Name SAINT JOSEPH MEDICAL GROUP
Street 114 N WASHINGTON ST
City BOURBON
State IN
ZIP 46504
Phone 574 335-7850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2024
Certificate Expiration Date 7/27/2026
Facility Type Physician Office
Lab Director CHARLES HIGGS COULTHARD

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