15D1099816 CLIA NUMBER - BEACON MEDICAL GROUP PEDIATRIC MULTI -SPECIALTY

Laboratory Demographics

  • CLIA Code: 15D1099816
  • Facility Name: BEACON MEDICAL GROUP PEDIATRIC MULTI -SPECIALTY
  • Facility Address: 100 NAVARRE PL STE 5550
    SOUTH BEND, IN
    ZIP 46601
  • Facility Phone: 574 647-2550
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ASAD ANSARI
  • NPI Number: 1548415474
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 15D1099816
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP PEDIATRIC MULTI -SPECIALTY
Street 100 NAVARRE PL STE 5550
City SOUTH BEND
State IN
ZIP 46601
Phone 574 647-2550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Physician Office
Lab Director ASAD ANSARI

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