15D0919558 CLIA NUMBER - DEACONESS CLINIC INC/PETERSBURG

Laboratory Demographics

  • CLIA Code: 15D0919558
  • Facility Name: DEACONESS CLINIC INC/PETERSBURG
  • Facility Address: 1004 EAST ILLINOIS STREET
    PETERSBURG, IN
    ZIP 47567
  • Facility Phone: 812 354-1052
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GARY J. KEEPES
  • NPI Number: 1831345792
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D0919558
LAB Type Physician Office
Facility Name DEACONESS CLINIC INC/PETERSBURG
Street 1004 EAST ILLINOIS STREET
City PETERSBURG
State IN
ZIP 47567
Phone 812 354-1052
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2025
Certificate Expiration Date 8/17/2027
Facility Type Physician Office
Lab Director GARY J. KEEPES

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