15D2057229 CLIA NUMBER - BEACON MEDICAL GROUP ENT AND AUDIOLOGY ELKHART

Laboratory Demographics

  • CLIA Code: 15D2057229
  • Facility Name: BEACON MEDICAL GROUP ENT AND AUDIOLOGY ELKHART
  • Facility Address: 1753 FULTON ST
    ELKHART, IN
    ZIP 46514
  • Facility Phone: 574 293-9448
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JOHN S. GILBERT
  • NPI Number: 1295087500
  • Taxonomy: 207YX0905X - Otolaryngology

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CLIA Record

Field Name Field Value
CLIA Number 15D2057229
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP ENT AND AUDIOLOGY ELKHART
Street 1753 FULTON ST
City ELKHART
State IN
ZIP 46514
Phone 574 293-9448
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2025
Certificate Expiration Date 4/10/2027
Facility Type Physician Office
Lab Director DR. JOHN S. GILBERT

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