15D2077271 CLIA NUMBER - FOUNTAIN COUNTY HEALTH DEPARTMENT

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Laboratory Demographics

CLIA Number: 15D2077271

Facility Name: FOUNTAIN COUNTY HEALTH DEPARTMENT

Facility Address:
113 W SYCAMORE STREET
ATTICA, IN
ZIP 47918
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Facility Phone Number: 765 762-3035

Facility Type: Public Health Laboratories

Certificate Type: Waiver

NPI Number: 1457816613

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	15D2077271
LAB Type	Public Health Laboratories
Facility Name	FOUNTAIN COUNTY HEALTH DEPARTMENT
Street	113 W SYCAMORE STREET
City	ATTICA
State	IN
ZIP	47918
Phone	765 762-3035
CertificateType	4
CertificateEffectiveDate	5/5/2024
CertificateExpirationDate	5/4/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024