15D2144696 CLIA NUMBER - DEACONESS CLINIC AT WORK BOONVILLE

Laboratory Demographics

  • CLIA Code: 15D2144696
  • Facility Name: DEACONESS CLINIC AT WORK BOONVILLE
  • Facility Address: 930 W MAIN ST
    BOONVILLE, IN
    ZIP 47601
  • Facility Phone: 812 641-0088
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SCOTT ULOTH
  • NPI Number: 1174026363
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2144696
LAB Type Physician Office
Facility Name DEACONESS CLINIC AT WORK BOONVILLE
Street 930 W MAIN ST
City BOONVILLE
State IN
ZIP 47601
Phone 812 641-0088
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Physician Office
Lab Director SCOTT ULOTH

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