15D2174101 CLIA NUMBER - JESC

Laboratory Demographics

CLIA Number: 15D2174101

Facility Name: JESC

Facility Address:
647 W 2ND ST
JASPER, IN
ZIP 47546
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Facility Phone Number: 812 266-2806

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1154887040

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2174101
LAB Type	Ambulatory Surgery Center
Facility Name	JESC
Street	647 W 2ND ST
City	JASPER
State	IN
ZIP	47546
Phone	812 266-2806
CertificateType	4
CertificateEffectiveDate	10/24/2023
CertificateExpirationDate	10/23/2025
FacilityType	Waiver

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