15D2012999 CLIA NUMBER - PROACTIVE MD VCSC HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2012999
  • Facility Name: PROACTIVE MD VCSC HEALTH CENTER
  • Facility Address: 3250 MAPLE AVE
    TERRE HAUTE, IN
    ZIP 47804
  • Facility Phone: 812 462-5799
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: KENNETH R. MASSEY
  • NPI Number: 1457078321
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2012999
LAB Type Practitioner Other
Facility Name PROACTIVE MD VCSC HEALTH CENTER
Street 3250 MAPLE AVE
City TERRE HAUTE
State IN
ZIP 47804
Phone 812 462-5799
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/13/2024
Certificate Expiration Date 9/12/2026
Facility Type Practitioner Other
Lab Director KENNETH R. MASSEY

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