15D1095134 CLIA NUMBER - INDIANA ENDOSCOPY CENTER AVON

Laboratory Demographics

CLIA Number: 15D1095134

Facility Name: INDIANA ENDOSCOPY CENTER AVON

Facility Address:
1115 N RONALD REAGAN PKWY STE 347
AVON, IN
ZIP 46123
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Facility Phone Number: 317 217-2111

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1811172729

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D1095134
LAB Type	Ambulatory Surgery Center
Facility Name	INDIANA ENDOSCOPY CENTER AVON
Street	1115 N RONALD REAGAN PKWY STE 347
City	AVON
State	IN
ZIP	46123
Phone	317 217-2111
CertificateType	4
CertificateEffectiveDate	2/3/2023
CertificateExpirationDate	2/2/2025
FacilityType	Waiver

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