15D0988541 CLIA NUMBER - VA NORTHERN INDIANA HCS-FORT WAYNE

Laboratory Demographics

CLIA Number: 15D0988541

Facility Name: VA NORTHERN INDIANA HCS-FORT WAYNE

Facility Address:
2121 LAKE AVE BLDG 1 RM 240-246
FORT WAYNE, IN
ZIP 46805
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Facility Phone Number: 219 460-1422

Facility Type: Hospital

Certificate Type: Accreditation

NPI Number: 1386028330

Taxonomy: 261QV0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D0988541
LAB Type	Hospital
Facility Name	VA NORTHERN INDIANA HCS-FORT WAYNE
Street	2121 LAKE AVE BLDG 1 RM 240-246
City	FORT WAYNE
State	IN
ZIP	46805
Phone	219 460-1422
CertificateType	1
CertificateEffectiveDate	6/29/2001
CertificateExpirationDate	5/22/2026
FacilityType	Accreditation

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This page was last updated on: 4/23/2024