15D0361024 CLIA NUMBER - JASPER PEDIATRIC OF MEMORIAL HOSPITAL

Laboratory Demographics

  • CLIA Code: 15D0361024
  • Facility Name: JASPER PEDIATRIC OF MEMORIAL HOSPITAL
  • Facility Address: 721 WEST 13TH STREET STE 321
    JASPER, IN
    ZIP 47546
  • Facility Phone: 812 482-7918
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DOUGLAS A. BIES
  • NPI Number: 1992752612
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 15D0361024
LAB Type Physician Office
Facility Name JASPER PEDIATRIC OF MEMORIAL HOSPITAL
Street 721 WEST 13TH STREET STE 321
City JASPER
State IN
ZIP 47546
Phone 812 482-7918
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/14/2023
Certificate Expiration Date 6/13/2025
Facility Type Physician Office
Lab Director DOUGLAS A. BIES

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This page was last updated on: 3/20/2025