15D0361322 CLIA NUMBER - DEACONESS CLINIC GIBSON HOSPITAL SUITE 2203 A - BRINK

Laboratory Demographics

  • CLIA Code: 15D0361322
  • Facility Name: DEACONESS CLINIC GIBSON HOSPITAL SUITE 2203 A - BRINK
  • Facility Address: 1808 SHERMAN SUITE 2203
    PRINCETON, IN
    ZIP 47670
  • Facility Phone: 812 385-9420
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRUCE BRINK JR
  • NPI Number: 1982216495
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0361322
LAB Type Physician Office
Facility Name DEACONESS CLINIC GIBSON HOSPITAL SUITE 2203 A - BRINK
Street 1808 SHERMAN SUITE 2203
City PRINCETON
State IN
ZIP 47670
Phone 812 385-9420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2023
Certificate Expiration Date 11/30/2025
Facility Type Physician Office
Lab Director BRUCE BRINK JR

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