15D2130494 CLIA NUMBER - CREDO FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 15D2130494

Facility Name: CREDO FAMILY MEDICINE

Facility Address:
10050 AUBURN PARK DR
FORT WAYNE, IN
ZIP 46825
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Facility Phone Number: 260 432-6459

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1407203672

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

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
CertificateType	4
CertificateEffectiveDate	5/10/2023
CertificateExpirationDate	5/9/2025
FacilityType	Waiver

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