15D2213427 CLIA NUMBER - INTEGRATED BODY AND MEDICINE, PC

Laboratory Demographics

  • CLIA Code: 15D2213427
  • Facility Name: INTEGRATED BODY AND MEDICINE, PC
  • Facility Address: 8145 KENNEDY AVENUE
    HIGHLAND, IN
    ZIP 46322
  • Facility Phone: 218 803-6630
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AHMAD SPROUSE
  • NPI Number: 1407404569
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 15D2213427
LAB Type Physician Office
Facility Name INTEGRATED BODY AND MEDICINE, PC
Street 8145 KENNEDY AVENUE
City HIGHLAND
State IN
ZIP 46322
Phone 218 803-6630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/12/2025
Certificate Expiration Date 2/11/2027
Facility Type Physician Office
Lab Director AHMAD SPROUSE

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