15D0932876 CLIA NUMBER - DAVIESS MARTIN MEDICAL CLINIC LAB

Laboratory Demographics

  • CLIA Code: 15D0932876
  • Facility Name: DAVIESS MARTIN MEDICAL CLINIC LAB
  • Facility Address: 12546 E US HWY 50
    LOOGOOTEE, IN
    ZIP 47553
  • Facility Phone: 812 295-5095
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DAVID NIBEL
  • NPI Number: 1417015884
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D0932876
LAB Type Rural Health Clinic
Facility Name DAVIESS MARTIN MEDICAL CLINIC LAB
Street 12546 E US HWY 50
City LOOGOOTEE
State IN
ZIP 47553
Phone 812 295-5095
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/29/2025
Certificate Expiration Date 8/28/2027
Facility Type Rural Health Clinic
Lab Director DAVID NIBEL

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