15D2097996 CLIA NUMBER - METHODIST PHY GRP - PCA OB

Laboratory Demographics

  • CLIA Code: 15D2097996
  • Facility Name: METHODIST PHY GRP - PCA OB
  • Facility Address: 8777 BROADWAY, STE D
    MERRILLVILLE, IN
    ZIP 46410
  • Facility Phone: 219 738-3536
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: VIDA MCGHEE-LEWIS
  • NPI Number: 1265109227
  • Taxonomy: 207RE0101X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2097996
LAB Type Physician Office
Facility Name METHODIST PHY GRP - PCA OB
Street 8777 BROADWAY, STE D
City MERRILLVILLE
State IN
ZIP 46410
Phone 219 738-3536
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/29/2025
Certificate Expiration Date 6/28/2027
Facility Type Physician Office
Lab Director VIDA MCGHEE-LEWIS

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