15D1007693 CLIA NUMBER - CLI SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 15D1007693
  • Facility Name: CLI SURGERY CENTER
  • Facility Address: 7747 W JEFFERSON STE B
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 459-8444
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RANDAL K. HUGHES
  • NPI Number: 1093778052
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D1007693
LAB Type Ambulatory Surgery Center
Facility Name CLI SURGERY CENTER
Street 7747 W JEFFERSON STE B
City FORT WAYNE
State IN
ZIP 46804
Phone 260 459-8444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2024
Certificate Expiration Date 12/26/2026
Facility Type Ambulatory Surgery Center
Lab Director RANDAL K. HUGHES

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