15D2082499 CLIA NUMBER - FERTILITY & MIDWIFERY CARE CTR, LLC

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Laboratory Demographics

CLIA Number: 15D2082499

Facility Name: FERTILITY & MIDWIFERY CARE CTR, LLC

Facility Address:
10228 DUPONT CIRCLE DR, STE 100
FORT WAYNE, IN
ZIP 46825
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Facility Phone Number: 260 222-7401

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376955070

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	15D2082499
LAB Type	Physician Office
Facility Name	FERTILITY & MIDWIFERY CARE CTR, LLC
Street	10228 DUPONT CIRCLE DR, STE 100
City	FORT WAYNE
State	IN
ZIP	46825
Phone	260 222-7401
CertificateType	4
CertificateEffectiveDate	8/15/2022
CertificateExpirationDate	8/14/2024
FacilityType	Waiver

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