15D0960553 CLIA NUMBER - PARK CENTER INC

Laboratory Demographics

  • CLIA Code: 15D0960553
  • Facility Name: PARK CENTER INC
  • Facility Address: 909 E STATE BLVD
    FORT WAYNE, IN
    ZIP 46805
  • Facility Phone: 260 481-2700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. AHSAN MAHMOOD
  • NPI Number: 1053594663
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 15D0960553
LAB Type Physician Office
Facility Name PARK CENTER INC
Street 909 E STATE BLVD
City FORT WAYNE
State IN
ZIP 46805
Phone 260 481-2700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2024
Certificate Expiration Date 3/26/2026
Facility Type Physician Office
Lab Director DR. AHSAN MAHMOOD

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