15D2003221 CLIA NUMBER - HENDRICKS REGIONAL HEALTH, AVON WELLNESS CENTER

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Laboratory Demographics

CLIA Number: 15D2003221

Facility Name: HENDRICKS REGIONAL HEALTH, AVON WELLNESS CENTER

Facility Address:
8244 E US HWY 36, SUITE 1310
AVON, IN
ZIP 46123
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Facility Phone Number: 317 544-6135

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1871825216

Taxonomy: 261QC1800X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2003221
LAB Type	Physician Office
Facility Name	HENDRICKS REGIONAL HEALTH, AVON WELLNESS CENTER
Street	8244 E US HWY 36, SUITE 1310
City	AVON
State	IN
ZIP	46123
Phone	317 544-6135
CertificateType	4
CertificateEffectiveDate	2/4/2024
CertificateExpirationDate	2/3/2026
FacilityType	Waiver

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