15D2074858 CLIA NUMBER - EVERSIDE HEALTH - SBCSC

Laboratory Demographics

  • CLIA Code: 15D2074858
  • Facility Name: EVERSIDE HEALTH - SBCSC
  • Facility Address: 611 LINCOLN WAY E
    SOUTH BEND, IN
    ZIP 46601
  • Facility Phone: 866 808-6005
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEAN MILLER
  • NPI Number: 1639840473
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2074858
LAB Type Physician Office
Facility Name EVERSIDE HEALTH - SBCSC
Street 611 LINCOLN WAY E
City SOUTH BEND
State IN
ZIP 46601
Phone 866 808-6005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2024
Certificate Expiration Date 3/17/2026
Facility Type Physician Office
Lab Director JEAN MILLER

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