15D2038601 CLIA NUMBER - OPTIMUM PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 15D2038601
  • Facility Name: OPTIMUM PRIMARY CARE, LLC
  • Facility Address: 7330 INDIANAPOLIS BLVD
    HAMMOND, IN
    ZIP 46324
  • Facility Phone: 219 844-1444
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KHALED A. REHEEM-FARAG
  • NPI Number: 1073748216
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2038601
LAB Type Physician Office
Facility Name OPTIMUM PRIMARY CARE, LLC
Street 7330 INDIANAPOLIS BLVD
City HAMMOND
State IN
ZIP 46324
Phone 219 844-1444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Physician Office
Lab Director KHALED A. REHEEM-FARAG

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