15D0997241 CLIA NUMBER - ST VINCENT EVANSVILLE MEDICAL GROUP/BELLEMEADE FAMILY PHYSICIANS

Laboratory Demographics

CLIA Number: 15D0997241

Facility Name: ST VINCENT EVANSVILLE MEDICAL GROUP/BELLEMEADE FAMILY PHYSICIANS

Facility Address:
3801 BELLEMEADE AVENUE, SUITE 200B
EVANSVILLE, IN
ZIP 47714
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Facility Phone Number: 812 485-3737

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1851950224

Taxonomy: 2080P0203X - Pediatrics
A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.

CLIA Record

Field Name	Field Value
CLIA Number	15D0997241
LAB Type	Physician Office
Facility Name	ST VINCENT EVANSVILLE MEDICAL GROUP/BELLEMEADE FAMILY PHYSICIANS
Street	3801 BELLEMEADE AVENUE, SUITE 200B
City	EVANSVILLE
State	IN
ZIP	47714
Phone	812 485-3737
CertificateType	4
CertificateEffectiveDate	12/14/2023
CertificateExpirationDate	12/13/2025
FacilityType	Waiver

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