15D2094051 CLIA NUMBER - WESTGATE MEDICAL, LLC

Laboratory Demographics

  • CLIA Code: 15D2094051
  • Facility Name: WESTGATE MEDICAL, LLC
  • Facility Address: 10858 E SR 54, STE 1
    BLOOMFIELD, IN
    ZIP 47424
  • Facility Phone: (812) 381-4252
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JODY L. ROOT
  • NPI Number: 1679971550
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 15D2094051
LAB Type Physician Office
Facility Name WESTGATE MEDICAL, LLC
Street 10858 E SR 54, STE 1
City BLOOMFIELD
State IN
ZIP 47424
Phone 8123814252
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Physician Office
Lab Director JODY L. ROOT

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This page was last updated on: 5/15/2026