15D0866928 CLIA NUMBER - CORYDON MEDICAL ASSOCIATES PC

Laboratory Demographics

  • CLIA Code: 15D0866928
  • Facility Name: CORYDON MEDICAL ASSOCIATES PC
  • Facility Address: 1263 HOSPITAL DR NW STE 170
    CORYDON, IN
    ZIP 47112
  • Facility Phone: 812 738-8136
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL BONACUM
  • NPI Number: 1740362805
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0866928
LAB Type Physician Office
Facility Name CORYDON MEDICAL ASSOCIATES PC
Street 1263 HOSPITAL DR NW STE 170
City CORYDON
State IN
ZIP 47112
Phone 812 738-8136
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2024
Certificate Expiration Date 2/22/2026
Facility Type Physician Office
Lab Director MICHAEL BONACUM

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