15D2138522 CLIA NUMBER - PROACTIVE MD MONROE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 15D2138522
  • Facility Name: PROACTIVE MD MONROE HEALTH CENTER
  • Facility Address: 524 N FAIRVIEW ST
    BLOOMINGTON, IN
    ZIP 47404
  • Facility Phone: 812 330-7837
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DAVID LUKENS
  • NPI Number: 1427569367
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2138522
LAB Type Practitioner Other
Facility Name PROACTIVE MD MONROE HEALTH CENTER
Street 524 N FAIRVIEW ST
City BLOOMINGTON
State IN
ZIP 47404
Phone 812 330-7837
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Practitioner Other
Lab Director DAVID LUKENS

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