15D2248893 CLIA NUMBER - LEGACII CLINICAL LABORATORY SERVICES, LLC

Laboratory Demographics

  • CLIA Code: 15D2248893
  • Facility Name: LEGACII CLINICAL LABORATORY SERVICES, LLC
  • Facility Address: 3500 DEPAUW BLVD STE 2053
    INDIANAPOLIS, IN
    ZIP 46268
  • Facility Phone: 317 918-7542
  • Facility Type: Other - DIAGNOSTIC TESTING
  • Facility Type: Waiver
  • Lab Director: L TIA R. LEWIS
  • NPI Number: 1205612215
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2248893
LAB Type Other - DIAGNOSTIC TESTING
Facility Name LEGACII CLINICAL LABORATORY SERVICES, LLC
Street 3500 DEPAUW BLVD STE 2053
City INDIANAPOLIS
State IN
ZIP 46268
Phone 317 918-7542
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2024
Certificate Expiration Date 1/17/2026
Facility Type Other - DIAGNOSTIC TESTING
Lab Director L TIA R. LEWIS

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