15D2230441 CLIA NUMBER - MEDICINE REIMAGINED DPC

Laboratory Demographics

  • CLIA Code: 15D2230441
  • Facility Name: MEDICINE REIMAGINED DPC
  • Facility Address: 1720 W LINCOLN AVE
    GOSHEN, IN
    ZIP 46526
  • Facility Phone: 574 319-1420
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KIMBERLY S. STUCKEY SCHROCK
  • NPI Number: 1891375275
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2230441
LAB Type Physician Office
Facility Name MEDICINE REIMAGINED DPC
Street 1720 W LINCOLN AVE
City GOSHEN
State IN
ZIP 46526
Phone 574 319-1420
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2025
Certificate Expiration Date 7/22/2027
Facility Type Physician Office
Lab Director KIMBERLY S. STUCKEY SCHROCK

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