15D1046178 CLIA NUMBER - PROVIDENCE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 15D1046178
  • Facility Name: PROVIDENCE MEDICAL GROUP
  • Facility Address: 2723 S 7TH ST STE A ATTN BABETTE BOLINGER
    TERRE HAUTE, IN
    ZIP 47802
  • Facility Phone: 812 299-8280
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GEORGE BITTAR
  • NPI Number: 1982778080
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 15D1046178
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL GROUP
Street 2723 S 7TH ST STE A ATTN BABETTE BOLINGER
City TERRE HAUTE
State IN
ZIP 47802
Phone 812 299-8280
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2025
Certificate Expiration Date 10/2/2027
Facility Type Physician Office
Lab Director GEORGE BITTAR

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