15D2176056 CLIA NUMBER - EVERSIDE HEALTH IBEW LOCAL 153/UA LOCAL 172 SOUTH BEND

Laboratory Demographics

  • CLIA Code: 15D2176056
  • Facility Name: EVERSIDE HEALTH IBEW LOCAL 153/UA LOCAL 172 SOUTH BEND
  • Facility Address: 3371 W CLEVELAND ROAD SUITE 120
    SOUTH BEND, IN
    ZIP 46628
  • Facility Phone: 574 218-6700
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: REBECCA ROCKERS
  • NPI Number: 1396021010
  • Taxonomy: 252Y00000X - Early Intervention Provider Agency

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CLIA Record

Field Name Field Value
CLIA Number 15D2176056
LAB Type Physician Office
Facility Name EVERSIDE HEALTH IBEW LOCAL 153/UA LOCAL 172 SOUTH BEND
Street 3371 W CLEVELAND ROAD SUITE 120
City SOUTH BEND
State IN
ZIP 46628
Phone 574 218-6700
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/30/2024
Certificate Expiration Date 3/29/2026
Facility Type Physician Office
Lab Director REBECCA ROCKERS

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