15D0360049 CLIA NUMBER - PAVILION PEDIATRIC CENTER, LLC

Laboratory Demographics

  • CLIA Code: 15D0360049
  • Facility Name: PAVILION PEDIATRIC CENTER, LLC
  • Facility Address: 3711 N EVERBROOK LANE
    MUNCIE, IN
    ZIP 47304
  • Facility Phone: 765 231-9494
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PRAKASH BHOOPALAM
  • NPI Number: 1063887438
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 15D0360049
LAB Type Physician Office
Facility Name PAVILION PEDIATRIC CENTER, LLC
Street 3711 N EVERBROOK LANE
City MUNCIE
State IN
ZIP 47304
Phone 765 231-9494
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2023
Certificate Expiration Date 7/23/2025
Facility Type Physician Office
Lab Director PRAKASH BHOOPALAM

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This page was last updated on: 6/4/2025