15D2084371 CLIA NUMBER - MSO CLINICS INC-D/B/A LAKESIDE FAMILY MEDICAL

Laboratory Demographics

  • CLIA Code: 15D2084371
  • Facility Name: MSO CLINICS INC-D/B/A LAKESIDE FAMILY MEDICAL
  • Facility Address: 2186 N HOSPITAL BLVD
    SULLIVAN, IN
    ZIP 47882
  • Facility Phone: 812 268-4311
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAULA K. HERRINGTON
  • NPI Number: 1154741296
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2084371
LAB Type Physician Office
Facility Name MSO CLINICS INC-D/B/A LAKESIDE FAMILY MEDICAL
Street 2186 N HOSPITAL BLVD
City SULLIVAN
State IN
ZIP 47882
Phone 812 268-4311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Physician Office
Lab Director PAULA K. HERRINGTON

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