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15D2157269 CLIA NUMBER - ASCENSION MEDICAL GROUP ST VINCENT-GREENWOOD PRIMARY, SPECIALTY CARE & WALK-IN CLINIC

Laboratory Demographics

CLIA Number: 15D2157269

Facility Name: ASCENSION MEDICAL GROUP ST VINCENT-GREENWOOD PRIMARY, SPECIALTY CARE & WALK-IN CLINIC

Facility Address:
1579 OLIVE BRANCH PARKE LANE, SUITE 180
GREENWOOD, IN
ZIP 46143
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Facility Phone Number: 317 879-4800

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1720555170

Taxonomy: 293D00000X - Physiological Laboratory
A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services.

CLIA Record

Field Name Field Value
CLIA Number 15D2157269
LAB Type Physician Office
Facility Name ASCENSION MEDICAL GROUP ST VINCENT-GREENWOOD PRIMARY, SPECIALTY CARE & WALK-IN CLINIC
Street 1579 OLIVE BRANCH PARKE LANE, SUITE 180
City GREENWOOD
State IN
ZIP 46143
Phone 317 879-4800
CertificateType 4
CertificateEffectiveDate 5/30/2023
CertificateExpirationDate 5/29/2025
FacilityType Waiver

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