15D0967449 CLIA NUMBER - GOSHEN FAMILY PHYSICIANS

Laboratory Demographics

  • CLIA Code: 15D0967449
  • Facility Name: GOSHEN FAMILY PHYSICIANS
  • Facility Address: 1811 CHARLTON CT
    GOSHEN, IN
    ZIP 46526
  • Facility Phone: 574 534-8200
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BETHANY A. WAIT
  • NPI Number: 1033292735
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D0967449
LAB Type Physician Office
Facility Name GOSHEN FAMILY PHYSICIANS
Street 1811 CHARLTON CT
City GOSHEN
State IN
ZIP 46526
Phone 574 534-8200
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 11/15/2023
Certificate Expiration Date 11/14/2025
Facility Type Physician Office
Lab Director BETHANY A. WAIT

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