15D2113106 CLIA NUMBER - BENTON COUNTY HEALTH AND WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 15D2113106
  • Facility Name: BENTON COUNTY HEALTH AND WELLNESS CENTER
  • Facility Address: 604 EAST 2ND STREET SUITE A
    FOWLER, IN
    ZIP 47944
  • Facility Phone: 765 885-2341
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PAMELA ROEDER
  • NPI Number: 1922143239
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 15D2113106
LAB Type Physician Office
Facility Name BENTON COUNTY HEALTH AND WELLNESS CENTER
Street 604 EAST 2ND STREET SUITE A
City FOWLER
State IN
ZIP 47944
Phone 765 885-2341
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2024
Certificate Expiration Date 5/16/2026
Facility Type Physician Office
Lab Director PAMELA ROEDER

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