15D0714939 CLIA NUMBER - BLOOMINGTON SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 15D0714939
  • Facility Name: BLOOMINGTON SURGERY CENTER
  • Facility Address: 1011 W SECOND ST
    BLOOMINGTON, IN
    ZIP 47403
  • Facility Phone: 812 334-1213
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: R DANIEL GROSSMAN
  • NPI Number: 1013999580
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D0714939
LAB Type Ambulatory Surgery Center
Facility Name BLOOMINGTON SURGERY CENTER
Street 1011 W SECOND ST
City BLOOMINGTON
State IN
ZIP 47403
Phone 812 334-1213
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Ambulatory Surgery Center
Lab Director R DANIEL GROSSMAN

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