15D2034389 CLIA NUMBER - PASSPORT HEALTH INDIANA

Laboratory Demographics

  • CLIA Code: 15D2034389
  • Facility Name: PASSPORT HEALTH INDIANA
  • Facility Address: 4745 STATESMEN DRIVE, #A
    INDIANAPOLIS, IN
    ZIP 46250
  • Facility Phone: 317 844-2990
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL DURS
  • NPI Number: 1154541795
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 15D2034389
LAB Type Physician Office
Facility Name PASSPORT HEALTH INDIANA
Street 4745 STATESMEN DRIVE, #A
City INDIANAPOLIS
State IN
ZIP 46250
Phone 317 844-2990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2024
Certificate Expiration Date 4/12/2026
Facility Type Physician Office
Lab Director MICHAEL DURS

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