15D0911967 CLIA NUMBER - ASCENSION MEDICAL GROUP ST VINCENT - PEDIATRICS DIAMOND VALLEY

Laboratory Demographics

  • CLIA Code: 15D0911967
  • Facility Name: ASCENSION MEDICAL GROUP ST VINCENT - PEDIATRICS DIAMOND VALLEY
  • Facility Address: 3838 N FIRST STREET SUITE C
    EVANSVILLE, IN
    ZIP 47710
  • Facility Phone: 812 422-6886
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GRACE ESAN
  • NPI Number: 1669226593
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0911967
LAB Type Physician Office
Facility Name ASCENSION MEDICAL GROUP ST VINCENT - PEDIATRICS DIAMOND VALLEY
Street 3838 N FIRST STREET SUITE C
City EVANSVILLE
State IN
ZIP 47710
Phone 812 422-6886
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2024
Certificate Expiration Date 2/19/2026
Facility Type Physician Office
Lab Director GRACE ESAN

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