15D1016288 CLIA NUMBER - PULASKI MEMORIAL HOSPITAL DBA MEDICAL AND SURGICAL GROUP

Laboratory Demographics

  • CLIA Code: 15D1016288
  • Facility Name: PULASKI MEMORIAL HOSPITAL DBA MEDICAL AND SURGICAL GROUP
  • Facility Address: 540 HOSPITAL DRIVE
    WINAMAC, IN
    ZIP 46996
  • Facility Phone: 574 946-2147
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLINT A. KAUFFMAN
  • NPI Number: 1528626652
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 15D1016288
LAB Type Physician Office
Facility Name PULASKI MEMORIAL HOSPITAL DBA MEDICAL AND SURGICAL GROUP
Street 540 HOSPITAL DRIVE
City WINAMAC
State IN
ZIP 46996
Phone 574 946-2147
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2023
Certificate Expiration Date 8/24/2025
Facility Type Physician Office
Lab Director CLINT A. KAUFFMAN

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This page was last updated on: 6/4/2025