15D1078025 CLIA NUMBER - ORTHOPEDIC & SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC

Laboratory Demographics

CLIA Number: 15D1078025

Facility Name: ORTHOPEDIC & SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC

Facility Address:
2310 CALIFORNIA ROAD, SUITE A
ELKHART, IN
ZIP 46514
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Facility Phone Number: 574 264-0791

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295397735

Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.

CLIA Record

Field Name	Field Value
CLIA Number	15D1078025
LAB Type	Physician Office
Facility Name	ORTHOPEDIC & SPORTS MEDICINE CENTER OF NORTHERN INDIANA, INC
Street	2310 CALIFORNIA ROAD, SUITE A
City	ELKHART
State	IN
ZIP	46514
Phone	574 264-0791
CertificateType	4
CertificateEffectiveDate	12/27/2023
CertificateExpirationDate	12/26/2025
FacilityType	Waiver

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