15D2041614 CLIA NUMBER - PREMISE HEALTH OF INDIANA MEDICAL, PC

Laboratory Demographics

  • CLIA Code: 15D2041614
  • Facility Name: PREMISE HEALTH OF INDIANA MEDICAL, PC
  • Facility Address: 100 WELLNESS CENTER
    NOTRE DAME, IN
    ZIP 46556
  • Facility Phone: 574 634-9355
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BENJAMIN GARMAN
  • NPI Number: 1801167879
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2041614
LAB Type Physician Office
Facility Name PREMISE HEALTH OF INDIANA MEDICAL, PC
Street 100 WELLNESS CENTER
City NOTRE DAME
State IN
ZIP 46556
Phone 574 634-9355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2024
Certificate Expiration Date 5/24/2026
Facility Type Physician Office
Lab Director BENJAMIN GARMAN

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This page was last updated on: 6/4/2025