15D1061322 CLIA NUMBER - LAFAYETTE STREET FAMILY HEALTH CLINIC

Laboratory Demographics

CLIA Number: 15D1061322

Facility Name: LAFAYETTE STREET FAMILY HEALTH CLINIC

Facility Address:
2700 S LAFAYETTE ST STE 200
FORT WAYNE, IN
ZIP 46806
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Facility Phone Number: 260 744-3000

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1003193814

Taxonomy: 213E00000X - Podiatrist
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.

CLIA Record

Field Name	Field Value
CLIA Number	15D1061322
LAB Type	Community Clinic
Facility Name	LAFAYETTE STREET FAMILY HEALTH CLINIC
Street	2700 S LAFAYETTE ST STE 200
City	FORT WAYNE
State	IN
ZIP	46806
Phone	260 744-3000
CertificateType	3
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024