15D0687550 CLIA NUMBER - EAGLE CREEK DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 15D0687550
  • Facility Name: EAGLE CREEK DERMATOLOGY
  • Facility Address: 6820 PARKDALE PL STE 211
    INDIANAPOLIS, IN
    ZIP 46254
  • Facility Phone: 317 329-7050
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: INGRIDA I. OZOLS
  • NPI Number: 1053561928
  • Taxonomy: 207NI0002X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 15D0687550
LAB Type Physician Office
Facility Name EAGLE CREEK DERMATOLOGY
Street 6820 PARKDALE PL STE 211
City INDIANAPOLIS
State IN
ZIP 46254
Phone 317 329-7050
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/3/2024
Certificate Expiration Date 1/2/2026
Facility Type Physician Office
Lab Director INGRIDA I. OZOLS

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