15D0357068 CLIA NUMBER - KOSCIUSKO MEDICAL GROUP D/B/A WARSAW WOMEN'S CENTER

Laboratory Demographics

  • CLIA Code: 15D0357068
  • Facility Name: KOSCIUSKO MEDICAL GROUP D/B/A WARSAW WOMEN'S CENTER
  • Facility Address: 1275 PROVIDENT DRIVE
    WARSAW, IN
    ZIP 46580
  • Facility Phone: 574 269-4026
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TIMOTHY COOK
  • NPI Number: 1083868269
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 15D0357068
LAB Type Physician Office
Facility Name KOSCIUSKO MEDICAL GROUP D/B/A WARSAW WOMEN'S CENTER
Street 1275 PROVIDENT DRIVE
City WARSAW
State IN
ZIP 46580
Phone 574 269-4026
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2024
Certificate Expiration Date 5/11/2026
Facility Type Physician Office
Lab Director TIMOTHY COOK

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