15D1039231 CLIA NUMBER - INDIANA UNIVERSITY HEALTH, INC

Laboratory Demographics

  • CLIA Code: 15D1039231
  • Facility Name: INDIANA UNIVERSITY HEALTH, INC
  • Facility Address: 7956 W JEFFERSON BLVD
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 436-2416
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AJAY S. GUPTA
  • NPI Number: 1366433369
  • Taxonomy: 207T00000X - Neurological Surgery

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CLIA Record

Field Name Field Value
CLIA Number 15D1039231
LAB Type Physician Office
Facility Name INDIANA UNIVERSITY HEALTH, INC
Street 7956 W JEFFERSON BLVD
City FORT WAYNE
State IN
ZIP 46804
Phone 260 436-2416
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Physician Office
Lab Director AJAY S. GUPTA

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