15D2028002 CLIA NUMBER - MARTINSVILLE CBOC

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Laboratory Demographics

CLIA Number: 15D2028002

Facility Name: MARTINSVILLE CBOC

Facility Address:
2200 JOHN R WOODEN DRIVE
MARTINSVILLE, IN
ZIP 46151
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Facility Phone Number: 317 988-2219

Facility Type: Community Clinic

Certificate Type: Accreditation

NPI Number: 1588035703

Taxonomy: 1223P0221X - Dentist
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

CLIA Record

Field Name	Field Value
CLIA Number	15D2028002
LAB Type	Community Clinic
Facility Name	MARTINSVILLE CBOC
Street	2200 JOHN R WOODEN DRIVE
City	MARTINSVILLE
State	IN
ZIP	46151
Phone	317 988-2219
CertificateType	1
CertificateEffectiveDate	8/8/2011
CertificateExpirationDate	5/22/2026
FacilityType	Accreditation

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