15D2006166 CLIA NUMBER - DEACONESS CLINIC REO

Laboratory Demographics

  • CLIA Code: 15D2006166
  • Facility Name: DEACONESS CLINIC REO
  • Facility Address: 3434 W STATE RD 66
    ROCKPORT, IN
    ZIP 47635
  • Facility Phone: 812 649-5061
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. SUSAN M. MARTIN
  • NPI Number: 1699921585
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2006166
LAB Type Physician Office
Facility Name DEACONESS CLINIC REO
Street 3434 W STATE RD 66
City ROCKPORT
State IN
ZIP 47635
Phone 812 649-5061
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2025
Certificate Expiration Date 4/21/2027
Facility Type Physician Office
Lab Director DR. SUSAN M. MARTIN

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