15D2164630 CLIA NUMBER - FORT WAYNE VASCULAR CARE, LLC

Laboratory Demographics

  • CLIA Code: 15D2164630
  • Facility Name: FORT WAYNE VASCULAR CARE, LLC
  • Facility Address: 1833 MAGNAVOX WAY #100
    FT WAYNE, IN
    ZIP 46804
  • Facility Phone: (260) 918-0997
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: CYNTHIA WIERSEMA
  • NPI Number: 1225684368
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2164630
LAB Type Ambulatory Surgery Center
Facility Name FORT WAYNE VASCULAR CARE, LLC
Street 1833 MAGNAVOX WAY #100
City FT WAYNE
State IN
ZIP 46804
Phone 2609180997
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2025
Certificate Expiration Date 4/9/2027
Facility Type Ambulatory Surgery Center
Lab Director CYNTHIA WIERSEMA

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This page was last updated on: 5/18/2026