15D0883389 CLIA NUMBER - AMERICAN NATIONAL RED CROSS-FORT WAYNE, IN, THE

Laboratory Demographics

CLIA Number: 15D0883389

Facility Name: AMERICAN NATIONAL RED CROSS-FORT WAYNE, IN, THE

Facility Address:
1212 E CALIFORNIA RD
FORT WAYNE, IN
ZIP 46825
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Facility Phone Number: 260 480-8209

Facility Type: Blood Bank

Certificate Type: Waiver

NPI Number: 1487196424

Taxonomy: 2086S0129X - Surgery
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

CLIA Record

Field Name	Field Value
CLIA Number	15D0883389
LAB Type	Blood Bank
Facility Name	AMERICAN NATIONAL RED CROSS-FORT WAYNE, IN, THE
Street	1212 E CALIFORNIA RD
City	FORT WAYNE
State	IN
ZIP	46825
Phone	260 480-8209
CertificateType	4
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024