15D2095759 CLIA NUMBER - STATE LINE FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 15D2095759
  • Facility Name: STATE LINE FAMILY MEDICINE
  • Facility Address: 535 WEST EATON PIKE
    RICHMOND, IN
    ZIP 47374
  • Facility Phone: 765 935-8862
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NELSON REED SPAULDING
  • NPI Number: 1316198633
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 15D2095759
LAB Type Physician Office
Facility Name STATE LINE FAMILY MEDICINE
Street 535 WEST EATON PIKE
City RICHMOND
State IN
ZIP 47374
Phone 765 935-8862
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2025
Certificate Expiration Date 5/8/2027
Facility Type Physician Office
Lab Director NELSON REED SPAULDING

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