15D1039614 CLIA NUMBER - ROSE INTERNAL MEDICINE PC

Laboratory Demographics

  • CLIA Code: 15D1039614
  • Facility Name: ROSE INTERNAL MEDICINE PC
  • Facility Address: 2205 W SUDBURY STE A
    BLOOMINGTON, IN
    ZIP 47403
  • Facility Phone: 812 961-1540
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES H. ROSE
  • NPI Number: 1992796718
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D1039614
LAB Type Physician Office
Facility Name ROSE INTERNAL MEDICINE PC
Street 2205 W SUDBURY STE A
City BLOOMINGTON
State IN
ZIP 47403
Phone 812 961-1540
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Physician Office
Lab Director CHARLES H. ROSE

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