15D2065611 CLIA NUMBER - PROACTIVE MD MADISON HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2065611
  • Facility Name: PROACTIVE MD MADISON HEALTH CENTER
  • Facility Address: 2580 MICHIGAN RD
    MADISON, IN
    ZIP 47250
  • Facility Phone: 812 801-4323
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: AMY HILL
  • NPI Number: 1548713332
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2065611
LAB Type Practitioner Other
Facility Name PROACTIVE MD MADISON HEALTH CENTER
Street 2580 MICHIGAN RD
City MADISON
State IN
ZIP 47250
Phone 812 801-4323
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2025
Certificate Expiration Date 9/10/2027
Facility Type Practitioner Other
Lab Director AMY HILL

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