15D1095339 CLIA NUMBER - PARKVIEW PACKNETT FAMILY CANCER INSTITUTE GENITOURINARY

Laboratory Demographics

  • CLIA Code: 15D1095339
  • Facility Name: PARKVIEW PACKNETT FAMILY CANCER INSTITUTE GENITOURINARY
  • Facility Address: 11050 PARKVIEW CIRCLE 2ND FLOOR
    FORT WAYNE, IN
    ZIP 46845
  • Facility Phone: 260 266-0234
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ZHENTAO ZHANG
  • NPI Number: 1669576997
  • Taxonomy: 2086S0127X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 15D1095339
LAB Type Physician Office
Facility Name PARKVIEW PACKNETT FAMILY CANCER INSTITUTE GENITOURINARY
Street 11050 PARKVIEW CIRCLE 2ND FLOOR
City FORT WAYNE
State IN
ZIP 46845
Phone 260 266-0234
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2024
Certificate Expiration Date 6/12/2026
Facility Type Physician Office
Lab Director ZHENTAO ZHANG

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