15D2018455 CLIA NUMBER - EAR, NOSE & THROAT ASSOC, PC

Laboratory Demographics

  • CLIA Code: 15D2018455
  • Facility Name: EAR, NOSE & THROAT ASSOC, PC
  • Facility Address: 10021 DUPONT CIR CT
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 426-8117
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: DAVID W. STEIN
  • NPI Number: 1619954468
  • Taxonomy: 207Y00000X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 15D2018455
LAB Type Ancillary Testing Site in Health Care Center
Facility Name EAR, NOSE & THROAT ASSOC, PC
Street 10021 DUPONT CIR CT
City FORT WAYNE
State IN
ZIP 46825
Phone 260 426-8117
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Ancillary Testing Site in Health Care Center
Lab Director DAVID W. STEIN

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