15D2046057 CLIA NUMBER - INTREPID OF SOUTHERN INDIANA, INC

Laboratory Demographics

  • CLIA Code: 15D2046057
  • Facility Name: INTREPID OF SOUTHERN INDIANA, INC
  • Facility Address: 2901 OHIO BOULEVARD, STE 210-2
    TERRE HAUTE, IN
    ZIP 47803
  • Facility Phone: 812 514-8200
  • Facility Type: Hospice
  • Facility Type: Waiver
  • Lab Director: MARTHA TRAVIOLI
  • NPI Number: 1538426598
  • Taxonomy: 251G00000X - Hospice Care, Community Based

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CLIA Record

Field Name Field Value
CLIA Number 15D2046057
LAB Type Hospice
Facility Name INTREPID OF SOUTHERN INDIANA, INC
Street 2901 OHIO BOULEVARD, STE 210-2
City TERRE HAUTE
State IN
ZIP 47803
Phone 812 514-8200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2023
Certificate Expiration Date 8/18/2025
Facility Type Hospice
Lab Director MARTHA TRAVIOLI

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