15D0886880 CLIA NUMBER - ASCENSION MEDICAL GROUP ST VINCENT - JENNINGS PRIMARY CARE & SPECIALTY CARE

Laboratory Demographics

CLIA Number: 15D0886880

Facility Name: ASCENSION MEDICAL GROUP ST VINCENT - JENNINGS PRIMARY CARE & SPECIALTY CARE

Facility Address:
301 HENRY ST
NORTH VERNON, IN
ZIP 47265
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Facility Phone Number: 812 352-4300

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1376816975

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D0886880
LAB Type	Physician Office
Facility Name	ASCENSION MEDICAL GROUP ST VINCENT - JENNINGS PRIMARY CARE & SPECIALTY CARE
Street	301 HENRY ST
City	NORTH VERNON
State	IN
ZIP	47265
Phone	812 352-4300
CertificateType	3
CertificateEffectiveDate	7/27/2023
CertificateExpirationDate	7/26/2025
FacilityType	PPMP

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