15D0865201 CLIA NUMBER - CHARLES B DINWIDDIE JR MD

Laboratory Demographics

  • CLIA Code: 15D0865201
  • Facility Name: CHARLES B DINWIDDIE JR MD
  • Facility Address: 3700 N EVERBROOK LN
    MUNCIE, IN
    ZIP 47304
  • Facility Phone: 317 288-8577
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHARLES B. DINWIDDIE JR
  • NPI Number: 1487656443
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 15D0865201
LAB Type Physician Office
Facility Name CHARLES B DINWIDDIE JR MD
Street 3700 N EVERBROOK LN
City MUNCIE
State IN
ZIP 47304
Phone 317 288-8577
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director CHARLES B. DINWIDDIE JR

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