15D2240866 CLIA NUMBER - PREMISE HEALTH OF INDIANA MEDICAL, PC

Laboratory Demographics

  • CLIA Code: 15D2240866
  • Facility Name: PREMISE HEALTH OF INDIANA MEDICAL, PC
  • Facility Address: 2815 INDIANAPOLIS BLVD MC 113
    WHITING, IN
    ZIP 46394
  • Facility Phone: 219 473-3222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KEVIN OSHEA
  • NPI Number: 1699446948
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2240866
LAB Type Physician Office
Facility Name PREMISE HEALTH OF INDIANA MEDICAL, PC
Street 2815 INDIANAPOLIS BLVD MC 113
City WHITING
State IN
ZIP 46394
Phone 219 473-3222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2023
Certificate Expiration Date 10/21/2025
Facility Type Physician Office
Lab Director KEVIN OSHEA

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This page was last updated on: 6/4/2025