15D2123096 CLIA NUMBER - PROACTIVE MD - DANA LAFAYETTE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2123096
  • Facility Name: PROACTIVE MD - DANA LAFAYETTE HEALTH CENTER
  • Facility Address: 2400 SAGAMORE PKWY SOUTH
    LAFAYETTE, IN
    ZIP 47903
  • Facility Phone: 765 772-4086
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: LAURA EMERY
  • NPI Number: 1790223048
  • Taxonomy: 261QP2300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2123096
LAB Type Practitioner Other
Facility Name PROACTIVE MD - DANA LAFAYETTE HEALTH CENTER
Street 2400 SAGAMORE PKWY SOUTH
City LAFAYETTE
State IN
ZIP 47903
Phone 765 772-4086
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Practitioner Other
Lab Director LAURA EMERY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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