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15D2167674 CLIA NUMBER - LUTHERAN MEDICAL GROUP, LLC DBA LUTHERAN HEALTH PHYSICIANS

Laboratory Demographics

CLIA Number: 15D2167674

Facility Name: LUTHERAN MEDICAL GROUP, LLC DBA LUTHERAN HEALTH PHYSICIANS

Facility Address:
1205 PROVIDENT DRIVE, SUITE A
WARSAW, IN
ZIP 46580
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Facility Phone Number: 574 269-8300

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1164475711

Taxonomy: 282N00000X - General Acute Care Hospital
An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity.

CLIA Record

Field Name Field Value
CLIA Number 15D2167674
LAB Type Physician Office
Facility Name LUTHERAN MEDICAL GROUP, LLC DBA LUTHERAN HEALTH PHYSICIANS
Street 1205 PROVIDENT DRIVE, SUITE A
City WARSAW
State IN
ZIP 46580
Phone 574 269-8300
CertificateType 4
CertificateEffectiveDate 6/12/2023
CertificateExpirationDate 6/11/2025
FacilityType Waiver

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