15D0356972 CLIA NUMBER - SYRACUSE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 15D0356972
  • Facility Name: SYRACUSE FAMILY PRACTICE
  • Facility Address: 1033 N INDIANA AVE
    SYRACUSE, IN
    ZIP 46567
  • Facility Phone: 574 457-5701
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LARRY D. ALLEN
  • NPI Number: 1770613879
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D0356972
LAB Type Physician Office
Facility Name SYRACUSE FAMILY PRACTICE
Street 1033 N INDIANA AVE
City SYRACUSE
State IN
ZIP 46567
Phone 574 457-5701
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/30/2024
Certificate Expiration Date 8/29/2026
Facility Type Physician Office
Lab Director LARRY D. ALLEN

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