15D1001693 CLIA NUMBER - THREE RIVERS DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 15D1001693
  • Facility Name: THREE RIVERS DERMATOLOGY
  • Facility Address: 5650 COVENTRY LN
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 436-9696
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. JEFFREY W. SASSMANNSHAUSEN
  • NPI Number: 1992991475
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 15D1001693
LAB Type Physician Office
Facility Name THREE RIVERS DERMATOLOGY
Street 5650 COVENTRY LN
City FORT WAYNE
State IN
ZIP 46804
Phone 260 436-9696
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 7/18/2024
Certificate Expiration Date 7/17/2026
Facility Type Physician Office
Lab Director DR. JEFFREY W. SASSMANNSHAUSEN

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