15D1015923 CLIA NUMBER - FAMILY MEDICINE OF CLOVERDALE

Laboratory Demographics

  • CLIA Code: 15D1015923
  • Facility Name: FAMILY MEDICINE OF CLOVERDALE
  • Facility Address: 51 E MARKET STREET
    CLOVERDALE, IN
    ZIP 46120
  • Facility Phone: 765 795-4242
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: KEITH LANDRY
  • NPI Number: 1578621389
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D1015923
LAB Type Rural Health Clinic
Facility Name FAMILY MEDICINE OF CLOVERDALE
Street 51 E MARKET STREET
City CLOVERDALE
State IN
ZIP 46120
Phone 765 795-4242
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 8/15/2025
Certificate Expiration Date 8/14/2027
Facility Type Rural Health Clinic
Lab Director KEITH LANDRY

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