15D2026595 CLIA NUMBER - LA PORTE CLINIC COMPANY, LLC D/B/A NORTHWEST MEDICAL GROUP - LAPORTE

Laboratory Demographics

  • CLIA Code: 15D2026595
  • Facility Name: LA PORTE CLINIC COMPANY, LLC D/B/A NORTHWEST MEDICAL GROUP - LAPORTE
  • Facility Address: 3777 NORTH FRONTAGE ROAD SUITE 300
    MICHIGAN CITY, IN
    ZIP 46360
  • Facility Phone: 219 324-0014
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JESSICA WILLIAMS
  • NPI Number: 1134309412
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2026595
LAB Type Physician Office
Facility Name LA PORTE CLINIC COMPANY, LLC D/B/A NORTHWEST MEDICAL GROUP - LAPORTE
Street 3777 NORTH FRONTAGE ROAD SUITE 300
City MICHIGAN CITY
State IN
ZIP 46360
Phone 219 324-0014
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2023
Certificate Expiration Date 7/5/2025
Facility Type Physician Office
Lab Director JESSICA WILLIAMS

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This page was last updated on: 3/20/2025