15D0693264 CLIA NUMBER - PROVIDENCE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 15D0693264
  • Facility Name: PROVIDENCE MEDICAL GROUP
  • Facility Address: 4001 WABASH AVE, STE C
    TERRE HAUTE, IN
    ZIP 47803
  • Facility Phone: (812) 232-8164
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HAROLD LOVEALL
  • NPI Number: 1891729141
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D0693264
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL GROUP
Street 4001 WABASH AVE, STE C
City TERRE HAUTE
State IN
ZIP 47803
Phone 8122328164
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/28/2025
Certificate Expiration Date 12/27/2027
Facility Type Physician Office
Lab Director HAROLD LOVEALL

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This page was last updated on: 5/18/2026