15D2051590 CLIA NUMBER - BLACKBIRD CLINICAL SERVICES

Laboratory Demographics

  • CLIA Code: 15D2051590
  • Facility Name: BLACKBIRD CLINICAL SERVICES
  • Facility Address: 2 EXECUTIVE DRIVE, STE D
    LAFAYETTE, IN
    ZIP 47905
  • Facility Phone: 765 447-8700
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: KIMI L. HATHAWAY
  • NPI Number: 1164669255
  • Taxonomy: 251K00000X - Public Health or Welfare

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CLIA Record

Field Name Field Value
CLIA Number 15D2051590
LAB Type Mobile Laboratory
Facility Name BLACKBIRD CLINICAL SERVICES
Street 2 EXECUTIVE DRIVE, STE D
City LAFAYETTE
State IN
ZIP 47905
Phone 765 447-8700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Mobile Laboratory
Lab Director KIMI L. HATHAWAY

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