15D0885928 CLIA NUMBER - MATTHEW 25 HEALTH & DENTAL CLINIC

Laboratory Demographics

  • CLIA Code: 15D0885928
  • Facility Name: MATTHEW 25 HEALTH & DENTAL CLINIC
  • Facility Address: 413 E JEFFERSON BLVD
    FORT WAYNE, IN
    ZIP 46802
  • Facility Phone: 260 426-4124
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRADLEY D. ISBISTER
  • NPI Number: 1992268635
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D0885928
LAB Type Physician Office
Facility Name MATTHEW 25 HEALTH & DENTAL CLINIC
Street 413 E JEFFERSON BLVD
City FORT WAYNE
State IN
ZIP 46802
Phone 260 426-4124
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2025
Certificate Expiration Date 3/13/2027
Facility Type Physician Office
Lab Director BRADLEY D. ISBISTER

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