15D2123312 CLIA NUMBER - ST JOSEPH CO AIRPORT AUTHORITY DEPT OF PUBLIC SAFETY

Laboratory Demographics

  • CLIA Code: 15D2123312
  • Facility Name: ST JOSEPH CO AIRPORT AUTHORITY DEPT OF PUBLIC SAFETY
  • Facility Address: 4821 LINCOLN WAY W
    SOUTH BEND, IN
    ZIP 46628
  • Facility Phone: 574 282-4593
  • Facility Type: Other - EMS RESPONDER
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. ORNAT
  • NPI Number: 1740510924
  • Taxonomy: 343900000X - Non-emergency Medical Transport (VAN)

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CLIA Record

Field Name Field Value
CLIA Number 15D2123312
LAB Type Other - EMS RESPONDER
Facility Name ST JOSEPH CO AIRPORT AUTHORITY DEPT OF PUBLIC SAFETY
Street 4821 LINCOLN WAY W
City SOUTH BEND
State IN
ZIP 46628
Phone 574 282-4593
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type Other - EMS RESPONDER
Lab Director MICHAEL J. ORNAT

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This page was last updated on: 6/4/2025