15D2150580 CLIA NUMBER - CONCENTRA - SOUTH BEND

Laboratory Demographics

  • CLIA Code: 15D2150580
  • Facility Name: CONCENTRA - SOUTH BEND
  • Facility Address: 19567 CLEVELAND ROAD
    SOUTH BEND, IN
    ZIP 46637
  • Facility Phone: 574 277-7600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MOHAMED MOHAMED
  • NPI Number: 1639665573
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2150580
LAB Type Physician Office
Facility Name CONCENTRA - SOUTH BEND
Street 19567 CLEVELAND ROAD
City SOUTH BEND
State IN
ZIP 46637
Phone 574 277-7600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type Physician Office
Lab Director MOHAMED MOHAMED

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