15D2063566 CLIA NUMBER - MONTGOMERY CO FREE CLINIC, INC

Laboratory Demographics

  • CLIA Code: 15D2063566
  • Facility Name: MONTGOMERY CO FREE CLINIC, INC
  • Facility Address: 816 S MILL ST
    CRAWFORDSVILLE, IN
    ZIP 47933
  • Facility Phone: 765 230-2784
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: DR. JOHN R. ROBERTS
  • NPI Number: 1508148131
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2063566
LAB Type Community Clinic
Facility Name MONTGOMERY CO FREE CLINIC, INC
Street 816 S MILL ST
City CRAWFORDSVILLE
State IN
ZIP 47933
Phone 765 230-2784
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/6/2025
Certificate Expiration Date 8/5/2027
Facility Type Community Clinic
Lab Director DR. JOHN R. ROBERTS

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