15D0713263 CLIA NUMBER - DEACONESS CLINIC AT WORK MT VERNON

Laboratory Demographics

  • CLIA Code: 15D0713263
  • Facility Name: DEACONESS CLINIC AT WORK MT VERNON
  • Facility Address: 813 E 4TH ST SUITE A
    MOUNT VERNON, IN
    ZIP 47620
  • Facility Phone: 812 490-0813
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JON S. ULOTH
  • NPI Number: 1376267799
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 15D0713263
LAB Type Physician Office
Facility Name DEACONESS CLINIC AT WORK MT VERNON
Street 813 E 4TH ST SUITE A
City MOUNT VERNON
State IN
ZIP 47620
Phone 812 490-0813
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/23/2023
Certificate Expiration Date 11/22/2025
Facility Type Physician Office
Lab Director DR. JON S. ULOTH

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