15D1019882 CLIA NUMBER - GOSHEN MEDICAL PRACTICE

Laboratory Demographics

  • CLIA Code: 15D1019882
  • Facility Name: GOSHEN MEDICAL PRACTICE
  • Facility Address: 2240 KARISA DR STE 1
    GOSHEN, IN
    ZIP 46526
  • Facility Phone: 574 534-6757
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DICKY G. BHAGAT
  • NPI Number: 1861582694
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D1019882
LAB Type Physician Office
Facility Name GOSHEN MEDICAL PRACTICE
Street 2240 KARISA DR STE 1
City GOSHEN
State IN
ZIP 46526
Phone 574 534-6757
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Physician Office
Lab Director DICKY G. BHAGAT

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