15D2232582 CLIA NUMBER - BEACON MEDICAL GROUP WANEE

Laboratory Demographics

  • CLIA Code: 15D2232582
  • Facility Name: BEACON MEDICAL GROUP WANEE
  • Facility Address: 2102 NORTH MAIN STREET
    NAPPANEE, IN
    ZIP 46550
  • Facility Phone: 574 862-2165
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ERIC J. MILLER
  • NPI Number: 1184641706
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2232582
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP WANEE
Street 2102 NORTH MAIN STREET
City NAPPANEE
State IN
ZIP 46550
Phone 574 862-2165
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2025
Certificate Expiration Date 8/15/2027
Facility Type Physician Office
Lab Director ERIC J. MILLER

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