15D2091875 CLIA NUMBER - PROACTIVE MD SPENCER HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2091875
  • Facility Name: PROACTIVE MD SPENCER HEALTH CENTER
  • Facility Address: 630 W STATE HIGHWAY 46
    SPENCER, IN
    ZIP 47460
  • Facility Phone: 888 862-9525
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: GENEVIEVE MUSCATELL
  • NPI Number: 1033662820
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2091875
LAB Type Practitioner Other
Facility Name PROACTIVE MD SPENCER HEALTH CENTER
Street 630 W STATE HIGHWAY 46
City SPENCER
State IN
ZIP 47460
Phone 888 862-9525
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/20/2025
Certificate Expiration Date 2/19/2027
Facility Type Practitioner Other
Lab Director GENEVIEVE MUSCATELL

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