15D2256964 CLIA NUMBER - IMAGING CENTER, THE

Laboratory Demographics

  • CLIA Code: 15D2256964
  • Facility Name: IMAGING CENTER, THE
  • Facility Address: 7631 WEST JEFFERSON BLVD
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 435-7770
  • Facility Type: Other - HOPD
  • Facility Type: Waiver
  • Lab Director: DAN BRANAM
  • NPI Number: 1457380453
  • Taxonomy: 261QE0800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2256964
LAB Type Other - HOPD
Facility Name IMAGING CENTER, THE
Street 7631 WEST JEFFERSON BLVD
City FORT WAYNE
State IN
ZIP 46804
Phone 260 435-7770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2024
Certificate Expiration Date 3/29/2026
Facility Type Other - HOPD
Lab Director DAN BRANAM

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