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15D1095000 CLIA NUMBER - SULLIVAN HEALTH & WELLNESS CLINIC AND WOMEN'S HEALTH CLINIC

Laboratory Demographics

CLIA Number: 15D1095000

Facility Name: SULLIVAN HEALTH & WELLNESS CLINIC AND WOMEN'S HEALTH CLINIC

Facility Address:
2232 N HOSPITAL BLVD SUITE 2
SULLIVAN, IN
ZIP 47882
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Facility Phone Number: 812 268-3318

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1497363303

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name Field Value
CLIA Number 15D1095000
LAB Type Physician Office
Facility Name SULLIVAN HEALTH & WELLNESS CLINIC AND WOMEN'S HEALTH CLINIC
Street 2232 N HOSPITAL BLVD SUITE 2
City SULLIVAN
State IN
ZIP 47882
Phone 812 268-3318
CertificateType 4
CertificateEffectiveDate 1/30/2023
CertificateExpirationDate 1/29/2025
FacilityType Waiver

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