15D1101762 CLIA NUMBER - BEACON MED GRP BITTERSWEET COMMONS

Laboratory Demographics

  • CLIA Code: 15D1101762
  • Facility Name: BEACON MED GRP BITTERSWEET COMMONS
  • Facility Address: 12340 BITTERSWEET COMMONS BLVD
    GRANGER, IN
    ZIP 46530
  • Facility Phone: 574 271-8610
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK P. SCHMELTZ
  • NPI Number: 1003042318
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D1101762
LAB Type Physician Office
Facility Name BEACON MED GRP BITTERSWEET COMMONS
Street 12340 BITTERSWEET COMMONS BLVD
City GRANGER
State IN
ZIP 46530
Phone 574 271-8610
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/6/2025
Certificate Expiration Date 7/5/2027
Facility Type Physician Office
Lab Director MARK P. SCHMELTZ

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