15D2123132 CLIA NUMBER - ELKHART CLINIC - D/B/A CONCORD FAMILY MEDICINE ATTN SHERRIE WHITE

Laboratory Demographics

CLIA Number: 15D2123132

Facility Name: ELKHART CLINIC - D/B/A CONCORD FAMILY MEDICINE ATTN SHERRIE WHITE

Facility Address:
25651 COUNTY ROAD 20
ELKHART, IN
ZIP 46517
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Facility Phone Number: 574 522-1201

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1730638990

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2123132
LAB Type	Physician Office
Facility Name	ELKHART CLINIC - D/B/A CONCORD FAMILY MEDICINE ATTN SHERRIE WHITE
Street	25651 COUNTY ROAD 20
City	ELKHART
State	IN
ZIP	46517
Phone	574 522-1201
CertificateType	1
CertificateEffectiveDate	10/13/2023
CertificateExpirationDate	10/12/2025
FacilityType	Accreditation

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This page was last updated on: 4/23/2024