15D0876295 CLIA NUMBER - JASPER DIALYSIS

Laboratory Demographics

  • CLIA Code: 15D0876295
  • Facility Name: JASPER DIALYSIS
  • Facility Address: 671 3RD AVE STE A
    JASPER, IN
    ZIP 47546
  • Facility Phone: 812 482-3205
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. RICHARD D MELLO
  • NPI Number: 1114983046
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D0876295
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name JASPER DIALYSIS
Street 671 3RD AVE STE A
City JASPER
State IN
ZIP 47546
Phone 812 482-3205
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2024
Certificate Expiration Date 4/12/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. RICHARD D MELLO

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