15D1008125 CLIA NUMBER - LAKESIDE SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 15D1008125
  • Facility Name: LAKESIDE SURGERY CENTER LLC
  • Facility Address: 810 W CHICAGO AVE
    EAST CHICAGO, IN
    ZIP 46312
  • Facility Phone: 219 392-0500
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: JACOB MATHEW
  • NPI Number: 1780886796
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D1008125
LAB Type Ambulatory Surgery Center
Facility Name LAKESIDE SURGERY CENTER LLC
Street 810 W CHICAGO AVE
City EAST CHICAGO
State IN
ZIP 46312
Phone 219 392-0500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2025
Certificate Expiration Date 1/9/2027
Facility Type Ambulatory Surgery Center
Lab Director JACOB MATHEW

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