15D2065622 CLIA NUMBER - PROACTIVE MD MONTEZUMA HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2065622
  • Facility Name: PROACTIVE MD MONTEZUMA HEALTH CENTER
  • Facility Address: 617 E STRAWBERRY ST
    MONTEZUMA, IN
    ZIP 47862
  • Facility Phone: 888 862-9525
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CARRIE DEAKINS
  • NPI Number: 1508319393
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2065622
LAB Type Practitioner Other
Facility Name PROACTIVE MD MONTEZUMA HEALTH CENTER
Street 617 E STRAWBERRY ST
City MONTEZUMA
State IN
ZIP 47862
Phone 888 862-9525
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2025
Certificate Expiration Date 9/11/2027
Facility Type Practitioner Other
Lab Director CARRIE DEAKINS

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