15D2232879 CLIA NUMBER - DEACONESS SPECIALTY PHYSICIANS, INC

Laboratory Demographics

  • CLIA Code: 15D2232879
  • Facility Name: DEACONESS SPECIALTY PHYSICIANS, INC
  • Facility Address: 120 SE FOURTH STREET, THIRD FLOOR
    EVANSVILLE, IN
    ZIP 47708
  • Facility Phone: 812 426-6638
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: YOUSEF ALTOWAIREB
  • NPI Number: 1407428519
  • Taxonomy: 207RE0101X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2232879
LAB Type Physician Office
Facility Name DEACONESS SPECIALTY PHYSICIANS, INC
Street 120 SE FOURTH STREET, THIRD FLOOR
City EVANSVILLE
State IN
ZIP 47708
Phone 812 426-6638
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2025
Certificate Expiration Date 8/17/2027
Facility Type Physician Office
Lab Director YOUSEF ALTOWAIREB

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