15D0678173 CLIA NUMBER - FORT WAYNE PEDIATRICS LAB

Laboratory Demographics

  • CLIA Code: 15D0678173
  • Facility Name: FORT WAYNE PEDIATRICS LAB
  • Facility Address: 2810 DUPONT COMMERCE CT
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 490-7337
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES E. BOLLIER
  • NPI Number: 1063595536
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 15D0678173
LAB Type Physician Office
Facility Name FORT WAYNE PEDIATRICS LAB
Street 2810 DUPONT COMMERCE CT
City FORT WAYNE
State IN
ZIP 46825
Phone 260 490-7337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2025
Certificate Expiration Date 1/2/2027
Facility Type Physician Office
Lab Director JAMES E. BOLLIER

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