15D0956271 CLIA NUMBER - SOUTHSIDE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 15D0956271
  • Facility Name: SOUTHSIDE FAMILY PRACTICE
  • Facility Address: 3554 PROMENADE PKWY STE F
    LAFAYETTE, IN
    ZIP 47909
  • Facility Phone: 765 471-9146
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOHN P. CUSACK
  • NPI Number: 1346413614
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0956271
LAB Type Physician Office
Facility Name SOUTHSIDE FAMILY PRACTICE
Street 3554 PROMENADE PKWY STE F
City LAFAYETTE
State IN
ZIP 47909
Phone 765 471-9146
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 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Physician Office
Lab Director JOHN P. CUSACK

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