15D2041154 CLIA NUMBER - RIVERVIEW SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 15D2041154
  • Facility Name: RIVERVIEW SURGERY CENTER, LLC
  • Facility Address: 1276 N PLAZA DR
    ROCKPORT, IN
    ZIP 47635
  • Facility Phone: 812 430-2051
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SHAFE DAVID BOLES
  • NPI Number: 1669748125
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2041154
LAB Type Ambulatory Surgery Center
Facility Name RIVERVIEW SURGERY CENTER, LLC
Street 1276 N PLAZA DR
City ROCKPORT
State IN
ZIP 47635
Phone 812 430-2051
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2024
Certificate Expiration Date 5/16/2026
Facility Type Ambulatory Surgery Center
Lab Director SHAFE DAVID BOLES

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