15D2102894 CLIA NUMBER - ST MARY MEDICAL CENTER OUTPATIENT CENTER

Laboratory Demographics

  • CLIA Code: 15D2102894
  • Facility Name: ST MARY MEDICAL CENTER OUTPATIENT CENTER
  • Facility Address: 3545 ARBORS ST - ATTN RADIOLOGY
    PORTAGE, IN
    ZIP 46368
  • Facility Phone: 219 947-6263
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: HEIDI NORDBROCK
  • NPI Number: 1649201351
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2102894
LAB Type Ancillary Testing Site in Health Care Center
Facility Name ST MARY MEDICAL CENTER OUTPATIENT CENTER
Street 3545 ARBORS ST - ATTN RADIOLOGY
City PORTAGE
State IN
ZIP 46368
Phone 219 947-6263
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Ancillary Testing Site in Health Care Center
Lab Director HEIDI NORDBROCK

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