15D0356768 CLIA NUMBER - BEACON MED GRP - MIDDLEBURY

Laboratory Demographics

  • CLIA Code: 15D0356768
  • Facility Name: BEACON MED GRP - MIDDLEBURY
  • Facility Address: 206 W WARREN ST
    MIDDLEBURY, IN
    ZIP 46540
  • Facility Phone: 574 825-2146
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES HANDTKE
  • NPI Number: 1114363835
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D0356768
LAB Type Physician Office
Facility Name BEACON MED GRP - MIDDLEBURY
Street 206 W WARREN ST
City MIDDLEBURY
State IN
ZIP 46540
Phone 574 825-2146
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2024
Certificate Expiration Date 6/19/2026
Facility Type Physician Office
Lab Director JAMES HANDTKE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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