15D2085229 CLIA NUMBER - WITHAM MEMORIAL HOSPITAL

Laboratory Demographics

  • CLIA Code: 15D2085229
  • Facility Name: WITHAM MEMORIAL HOSPITAL
  • Facility Address: 400 N MOUNT ZION RD
    LEBANON, IN
    ZIP 46052
  • Facility Phone: 765 335-0123
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANIEL E. KRAFT
  • NPI Number: 1992276745
  • Taxonomy: 225100000X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 15D2085229
LAB Type Physician Office
Facility Name WITHAM MEMORIAL HOSPITAL
Street 400 N MOUNT ZION RD
City LEBANON
State IN
ZIP 46052
Phone 765 335-0123
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2024
Certificate Expiration Date 10/8/2026
Facility Type Physician Office
Lab Director DANIEL E. KRAFT

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