15D2145477 CLIA NUMBER - KOKOMO AMBULATORY SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 15D2145477
  • Facility Name: KOKOMO AMBULATORY SURGERY CENTER LLC
  • Facility Address: 107 SOUTH WASHINGTON STREET
    KOKOMO, IN
    ZIP 46901
  • Facility Phone: 765 714-4344
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: SHAZIA M. SIDDIQUI
  • NPI Number: 1609376409
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2145477
LAB Type Ambulatory Surgery Center
Facility Name KOKOMO AMBULATORY SURGERY CENTER LLC
Street 107 SOUTH WASHINGTON STREET
City KOKOMO
State IN
ZIP 46901
Phone 765 714-4344
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Ambulatory Surgery Center
Lab Director SHAZIA M. SIDDIQUI

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