15D2182082 CLIA NUMBER - PROACTIVE MD - NEW PRAIRIE

Laboratory Demographics

  • CLIA Code: 15D2182082
  • Facility Name: PROACTIVE MD - NEW PRAIRIE
  • Facility Address: 5325 N COUGAR RD
    NEW CARLISLE, IN
    ZIP 46552
  • Facility Phone: 864 501-0751
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SANDRIA NIXON
  • NPI Number: 1285359679
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2182082
LAB Type Physician Office
Facility Name PROACTIVE MD - NEW PRAIRIE
Street 5325 N COUGAR RD
City NEW CARLISLE
State IN
ZIP 46552
Phone 864 501-0751
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2024
Certificate Expiration Date 4/14/2026
Facility Type Physician Office
Lab Director SANDRIA NIXON

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