15D0886498 CLIA NUMBER - ST LUKE'S MEDICAL MINISTRY

Laboratory Demographics

CLIA Number: 15D0886498

Facility Name: ST LUKE'S MEDICAL MINISTRY

Facility Address:
1441 NORTH GARDNER MEDICAL SPECIALTY CENTER PO BOX 677
SCOTTSBURG, IN
ZIP 47170
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Facility Phone Number: 812 752-4055

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1912923285

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D0886498
LAB Type	Physician Office
Facility Name	ST LUKE'S MEDICAL MINISTRY
Street	1441 NORTH GARDNER MEDICAL SPECIALTY CENTER PO BOX 677
City	SCOTTSBURG
State	IN
ZIP	47170
Phone	812 752-4055
CertificateType	3
CertificateEffectiveDate	5/20/2022
CertificateExpirationDate	5/19/2024
FacilityType	PPMP

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