15D2130494 CLIA NUMBER - CREDO FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 15D2130494
  • Facility Name: CREDO FAMILY MEDICINE
  • Facility Address: 10050 AUBURN PARK DR
    FORT WAYNE, IN
    ZIP 46825
  • Facility Phone: 260 432-6459
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREW J. MULLALLY
  • NPI Number: 1407203672
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2130494
LAB Type Physician Office
Facility Name CREDO FAMILY MEDICINE
Street 10050 AUBURN PARK DR
City FORT WAYNE
State IN
ZIP 46825
Phone 260 432-6459
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2025
Certificate Expiration Date 5/9/2027
Facility Type Physician Office
Lab Director ANDREW J. MULLALLY

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