15D2062803 CLIA NUMBER - NEPHROLOGY PHYSICIAN, LLC

Laboratory Demographics

  • CLIA Code: 15D2062803
  • Facility Name: NEPHROLOGY PHYSICIAN, LLC
  • Facility Address: 250 E DAY ROAD STE 300
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 574 968-0283
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BASHAR ERICSOOSSI
  • NPI Number: 1972503548
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2062803
LAB Type Physician Office
Facility Name NEPHROLOGY PHYSICIAN, LLC
Street 250 E DAY ROAD STE 300
City MISHAWAKA
State IN
ZIP 46545
Phone 574 968-0283
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2025
Certificate Expiration Date 7/22/2027
Facility Type Physician Office
Lab Director BASHAR ERICSOOSSI

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