15D0712697 CLIA NUMBER - BEACON MEDICAL GROUP BRISTOL

Laboratory Demographics

  • CLIA Code: 15D0712697
  • Facility Name: BEACON MEDICAL GROUP BRISTOL
  • Facility Address: 306 E VISTULA ST
    BRISTOL, IN
    ZIP 46507
  • Facility Phone: (574) 848-4427
  • Facility Type: Health Main. Organization
  • Facility Type: Waiver
  • Lab Director: JUSTIN GRANNELL
  • NPI Number: 1447285697
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D0712697
LAB Type Health Main. Organization
Facility Name BEACON MEDICAL GROUP BRISTOL
Street 306 E VISTULA ST
City BRISTOL
State IN
ZIP 46507
Phone 5748484427
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2025
Certificate Expiration Date 2/19/2027
Facility Type Health Main. Organization
Lab Director JUSTIN GRANNELL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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