15D0986622 CLIA NUMBER - ASSOCIATED SURGEONS AND PHYSICIANS, LLC

Laboratory Demographics

  • CLIA Code: 15D0986622
  • Facility Name: ASSOCIATED SURGEONS AND PHYSICIANS, LLC
  • Facility Address: 7988 W JEFFERSON BLVD
    FORT WAYNE, IN
    ZIP 46815
  • Facility Phone: 260 432-4400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEITH R. DAVIS
  • NPI Number: 1487809588
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 15D0986622
LAB Type Physician Office
Facility Name ASSOCIATED SURGEONS AND PHYSICIANS, LLC
Street 7988 W JEFFERSON BLVD
City FORT WAYNE
State IN
ZIP 46815
Phone 260 432-4400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2024
Certificate Expiration Date 11/11/2026
Facility Type Physician Office
Lab Director KEITH R. DAVIS

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