15D1024254 CLIA NUMBER - CONCENTRA URGENT CARE

Laboratory Demographics

  • CLIA Code: 15D1024254
  • Facility Name: CONCENTRA URGENT CARE
  • Facility Address: 5604 W 74TH ST
    INDIANAPOLIS, IN
    ZIP 46278
  • Facility Phone: 317 290-1551
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RAPHAEL VILLAVICENCIO
  • NPI Number: 1801071196
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D1024254
LAB Type Physician Office
Facility Name CONCENTRA URGENT CARE
Street 5604 W 74TH ST
City INDIANAPOLIS
State IN
ZIP 46278
Phone 317 290-1551
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/24/2024
Certificate Expiration Date 5/23/2026
Facility Type Physician Office
Lab Director DR. RAPHAEL VILLAVICENCIO

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