15D2126304 CLIA NUMBER - MARION GENERAL HOSPITAL DBA FAIRMOUNT MEDICAL ASSOCIATES

Laboratory Demographics

  • CLIA Code: 15D2126304
  • Facility Name: MARION GENERAL HOSPITAL DBA FAIRMOUNT MEDICAL ASSOCIATES
  • Facility Address: 157 W 8TH ST
    FAIRMOUNT, IN
    ZIP 46928
  • Facility Phone: 765 660-7880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VAHID DAVID SEDAGHAT
  • NPI Number: 1154474542
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2126304
LAB Type Physician Office
Facility Name MARION GENERAL HOSPITAL DBA FAIRMOUNT MEDICAL ASSOCIATES
Street 157 W 8TH ST
City FAIRMOUNT
State IN
ZIP 46928
Phone 765 660-7880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2025
Certificate Expiration Date 2/22/2027
Facility Type Physician Office
Lab Director VAHID DAVID SEDAGHAT

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