15D2108900 CLIA NUMBER - SAINT JOSEPH MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 15D2108900
  • Facility Name: SAINT JOSEPH MEDICAL GROUP
  • Facility Address: 611 E DOUGLAS RD, STE 402
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 574 335-7750
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES HIGGS COULTHARD
  • NPI Number: 1790738854
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 15D2108900
LAB Type Physician Office
Facility Name SAINT JOSEPH MEDICAL GROUP
Street 611 E DOUGLAS RD, STE 402
City MISHAWAKA
State IN
ZIP 46545
Phone 574 335-7750
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2024
Certificate Expiration Date 2/15/2026
Facility Type Physician Office
Lab Director CHARLES HIGGS COULTHARD

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