15D0966903 CLIA NUMBER - EASTSIDE FAMILY MEDICINE ATTN MGMT CLIA REGULATORY CERTIFICATION

Laboratory Demographics

  • CLIA Code: 15D0966903
  • Facility Name: EASTSIDE FAMILY MEDICINE ATTN MGMT CLIA REGULATORY CERTIFICATION
  • Facility Address: 2056 LEBANON RD
    CRAWFORDSVILLE, IN
    ZIP 47933
  • Facility Phone: 765 361-9930
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BARRY A. MATHISON
  • NPI Number: 1609940105
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0966903
LAB Type Physician Office
Facility Name EASTSIDE FAMILY MEDICINE ATTN MGMT CLIA REGULATORY CERTIFICATION
Street 2056 LEBANON RD
City CRAWFORDSVILLE
State IN
ZIP 47933
Phone 765 361-9930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/14/2024
Certificate Expiration Date 9/13/2026
Facility Type Physician Office
Lab Director BARRY A. MATHISON

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