15D2165964 CLIA NUMBER - WHEATFIELD PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 15D2165964
  • Facility Name: WHEATFIELD PRIMARY CARE
  • Facility Address: 3988 WEST SR 10
    WHEATFIELD, IN
    ZIP 46392
  • Facility Phone: 219 987-3581
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID VANDER LUGT
  • NPI Number: 1891704342
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 15D2165964
LAB Type Physician Office
Facility Name WHEATFIELD PRIMARY CARE
Street 3988 WEST SR 10
City WHEATFIELD
State IN
ZIP 46392
Phone 219 987-3581
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2025
Certificate Expiration Date 5/7/2027
Facility Type Physician Office
Lab Director DAVID VANDER LUGT

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