15D2009317 CLIA NUMBER - PLUM CREEK CENTER

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Laboratory Demographics

CLIA Number: 15D2009317

Facility Name: PLUM CREEK CENTER

Facility Address:
222 INDIANAPOLIS BLVD
SCHERERVILLE, IN
ZIP 46375
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Facility Phone Number: 773 702-6628

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043080674

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2009317
LAB Type	Physician Office
Facility Name	PLUM CREEK CENTER
Street	222 INDIANAPOLIS BLVD
City	SCHERERVILLE
State	IN
ZIP	46375
Phone	773 702-6628
CertificateType	4
CertificateEffectiveDate	6/30/2022
CertificateExpirationDate	6/29/2024
FacilityType	Waiver

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