15D2119406 CLIA NUMBER - PROACTIVE MD-TCG

Laboratory Demographics

  • CLIA Code: 15D2119406
  • Facility Name: PROACTIVE MD-TCG
  • Facility Address: 20 N 3RD STREET
    LAFAYETTE, IN
    ZIP 47901
  • Facility Phone: 765 423-9365
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMANDA SHEA
  • NPI Number: 1821535287
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2119406
LAB Type Physician Office
Facility Name PROACTIVE MD-TCG
Street 20 N 3RD STREET
City LAFAYETTE
State IN
ZIP 47901
Phone 765 423-9365
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Physician Office
Lab Director AMANDA SHEA

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