15D2175245 CLIA NUMBER - DBA FOUNDATIONS FAMILY MEDICINE WELL CARE COMMUNITY HEALTH, INC

Laboratory Demographics

  • CLIA Code: 15D2175245
  • Facility Name: DBA FOUNDATIONS FAMILY MEDICINE WELL CARE COMMUNITY HEALTH, INC
  • Facility Address: 314 S FERGUSON ST
    HENRYVILLE, IN
    ZIP 47126
  • Facility Phone: 812 794-8100
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: WILLIAM E. COOKE JR
  • NPI Number: 1720097322
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2175245
LAB Type Federally Qualified Health Center
Facility Name DBA FOUNDATIONS FAMILY MEDICINE WELL CARE COMMUNITY HEALTH, INC
Street 314 S FERGUSON ST
City HENRYVILLE
State IN
ZIP 47126
Phone 812 794-8100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Federally Qualified Health Center
Lab Director WILLIAM E. COOKE JR

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