15D2071644 CLIA NUMBER - ROSE-HULMAN INST OF TECH HLTH SVC CLINIC

Laboratory Demographics

  • CLIA Code: 15D2071644
  • Facility Name: ROSE-HULMAN INST OF TECH HLTH SVC CLINIC
  • Facility Address: 5500 WABASH AVE HULMAN UNION BLDG, RM 135
    TERRE HAUTE, IN
    ZIP 47803
  • Facility Phone: 812 877-8367
  • Facility Type: School/Student Health Service
  • Facility Type: Microscopy
  • Lab Director: MARK J. SCHULD
  • NPI Number: 1184028912
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2071644
LAB Type School/Student Health Service
Facility Name ROSE-HULMAN INST OF TECH HLTH SVC CLINIC
Street 5500 WABASH AVE HULMAN UNION BLDG, RM 135
City TERRE HAUTE
State IN
ZIP 47803
Phone 812 877-8367
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 4/18/2025
Certificate Expiration Date 4/17/2027
Facility Type School/Student Health Service
Lab Director MARK J. SCHULD

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