15D2065624 CLIA NUMBER - PROACTIVE MD BRAZIL HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2065624
  • Facility Name: PROACTIVE MD BRAZIL HEALTH CENTER
  • Facility Address: 501 E JACKSON ST A
    BRAZIL, IN
    ZIP 47834
  • Facility Phone: 888 862-9525
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JANICE HIGGINS
  • NPI Number: 1174076145
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2065624
LAB Type Practitioner Other
Facility Name PROACTIVE MD BRAZIL HEALTH CENTER
Street 501 E JACKSON ST A
City BRAZIL
State IN
ZIP 47834
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 JANICE HIGGINS

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