15D1018741 CLIA NUMBER - DEACONESS FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 15D1018741
  • Facility Name: DEACONESS FAMILY MEDICINE
  • Facility Address: 415 W COLUMBIA, STE 100
    EVANSVILLE, IN
    ZIP 47710
  • Facility Phone: 812 450-6200
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MOLLIE M. WETSTEIN
  • NPI Number: 1457371775
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D1018741
LAB Type Physician Office
Facility Name DEACONESS FAMILY MEDICINE
Street 415 W COLUMBIA, STE 100
City EVANSVILLE
State IN
ZIP 47710
Phone 812 450-6200
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 10/30/2023
Certificate Expiration Date 10/29/2025
Facility Type Physician Office
Lab Director MOLLIE M. WETSTEIN

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