15D0955447 CLIA NUMBER - BEACON MEDICAL GROUP GOSHEN

Laboratory Demographics

  • CLIA Code: 15D0955447
  • Facility Name: BEACON MEDICAL GROUP GOSHEN
  • Facility Address: 2120 RIETH BLVD STE 300
    GOSHEN, IN
    ZIP 46526
  • Facility Phone: 574 875-6911
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: FERNANDO S. ESCOVAR
  • NPI Number: 1689691297
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0955447
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP GOSHEN
Street 2120 RIETH BLVD STE 300
City GOSHEN
State IN
ZIP 46526
Phone 574 875-6911
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/6/2024
Certificate Expiration Date 9/5/2026
Facility Type Physician Office
Lab Director FERNANDO S. ESCOVAR

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