15D2129135 CLIA NUMBER - PROACTIVE VINCENNES HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2129135
  • Facility Name: PROACTIVE VINCENNES HEALTH CENTER
  • Facility Address: 1602 N UPPER 11TH
    VINCENNES, IN
    ZIP 47591
  • Facility Phone: 812 886-4557
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TONYA QUEEN
  • NPI Number: 1326577396
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2129135
LAB Type Practitioner Other
Facility Name PROACTIVE VINCENNES HEALTH CENTER
Street 1602 N UPPER 11TH
City VINCENNES
State IN
ZIP 47591
Phone 812 886-4557
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Practitioner Other
Lab Director TONYA QUEEN

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