15D1030552 CLIA NUMBER - SULLIVAN SURGICENTER LLC

Laboratory Demographics

  • CLIA Code: 15D1030552
  • Facility Name: SULLIVAN SURGICENTER LLC
  • Facility Address: 320 N SECTION ST
    SULLIVAN, IN
    ZIP 47882
  • Facility Phone: 812 268-9000
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KELLY J. GILHAM
  • NPI Number: 1700854072
  • Taxonomy: 261QA1903X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D1030552
LAB Type Ambulatory Surgery Center
Facility Name SULLIVAN SURGICENTER LLC
Street 320 N SECTION ST
City SULLIVAN
State IN
ZIP 47882
Phone 812 268-9000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2024
Certificate Expiration Date 9/8/2026
Facility Type Ambulatory Surgery Center
Lab Director KELLY J. GILHAM

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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