15D1005772 CLIA NUMBER - NORTHEAST INTERNAL MEDICINE ASSC PC PO BOX 236

Laboratory Demographics

  • CLIA Code: 15D1005772
  • Facility Name: NORTHEAST INTERNAL MEDICINE ASSC PC PO BOX 236
  • Facility Address: 2500 N DETROIT ST
    LAGRANGE, IN
    ZIP 46761
  • Facility Phone: 260 463-2133
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SHASHANK KASHYAP
  • NPI Number: 1366859779
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 15D1005772
LAB Type Physician Office
Facility Name NORTHEAST INTERNAL MEDICINE ASSC PC PO BOX 236
Street 2500 N DETROIT ST
City LAGRANGE
State IN
ZIP 46761
Phone 260 463-2133
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/30/2024
Certificate Expiration Date 10/29/2026
Facility Type Physician Office
Lab Director SHASHANK KASHYAP

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