15D2092411 CLIA NUMBER - PROACTIVE MD - GREATER CLARK HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2092411
  • Facility Name: PROACTIVE MD - GREATER CLARK HEALTH CENTER
  • Facility Address: 6200 E HWY 62
    JEFFERSONVILLE, IN
    ZIP 47130
  • Facility Phone: 812 214-0460
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MARY ROBERTS
  • NPI Number: 1548713514
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2092411
LAB Type Practitioner Other
Facility Name PROACTIVE MD - GREATER CLARK HEALTH CENTER
Street 6200 E HWY 62
City JEFFERSONVILLE
State IN
ZIP 47130
Phone 812 214-0460
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Practitioner Other
Lab Director MARY ROBERTS

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