15D2192144 CLIA NUMBER - 219 HEALTH NETWORK

Laboratory Demographics

  • CLIA Code: 15D2192144
  • Facility Name: 219 HEALTH NETWORK
  • Facility Address: 4320 FIR STREET SUITE 307
    EAST CHICAGO, IN
    ZIP 46312
  • Facility Phone: 219 703-9629
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALFONSO BLUM
  • NPI Number: 1265994636
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2192144
LAB Type Physician Office
Facility Name 219 HEALTH NETWORK
Street 4320 FIR STREET SUITE 307
City EAST CHICAGO
State IN
ZIP 46312
Phone 219 703-9629
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Physician Office
Lab Director ALFONSO BLUM

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