15D0714505 CLIA NUMBER - BEACON MED GRP ELKHART EAST

Laboratory Demographics

  • CLIA Code: 15D0714505
  • Facility Name: BEACON MED GRP ELKHART EAST
  • Facility Address: 3301 CR 6 E
    ELKHART, IN
    ZIP 46514
  • Facility Phone: 574 264-9635
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAVID DYCK
  • NPI Number: 1639196249
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0714505
LAB Type Physician Office
Facility Name BEACON MED GRP ELKHART EAST
Street 3301 CR 6 E
City ELKHART
State IN
ZIP 46514
Phone 574 264-9635
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 6/22/2025
Certificate Expiration Date 6/21/2027
Facility Type Physician Office
Lab Director DAVID DYCK

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