15D0672317 CLIA NUMBER - ALLEN COUNTY DEPT OF HEALTH

Laboratory Demographics

CLIA Number: 15D0672317

Facility Name: ALLEN COUNTY DEPT OF HEALTH

Facility Address:
4813 NEW HAVEN AVENUE
FORT WAYNE, IN
ZIP 46803
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Facility Phone Number: 260 449-3021

Facility Type: Public Health Laboratories

Certificate Type: Waiver

NPI Number: 1649422668

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	15D0672317
LAB Type	Public Health Laboratories
Facility Name	ALLEN COUNTY DEPT OF HEALTH
Street	4813 NEW HAVEN AVENUE
City	FORT WAYNE
State	IN
ZIP	46803
Phone	260 449-3021
CertificateType	4
CertificateEffectiveDate	7/15/2023
CertificateExpirationDate	7/14/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024