15D2091878 CLIA NUMBER - PROACTIVE MD - CRAWFORDSVILLE

Laboratory Demographics

  • CLIA Code: 15D2091878
  • Facility Name: PROACTIVE MD - CRAWFORDSVILLE
  • Facility Address: 1615 US HWY 231 S
    CRAWFORDSVILLE, IN
    ZIP 47933
  • Facility Phone: 765 323-4689
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER HOLLADAY
  • NPI Number: 1649913492
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2091878
LAB Type Physician Office
Facility Name PROACTIVE MD - CRAWFORDSVILLE
Street 1615 US HWY 231 S
City CRAWFORDSVILLE
State IN
ZIP 47933
Phone 765 323-4689
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 Physician Office
Lab Director JENNIFER HOLLADAY

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