15D2266118 CLIA NUMBER - NORTHEAST INDIANA AMBULATORY SURGERY CENTER

Laboratory Demographics

CLIA Number: 15D2266118

Facility Name: NORTHEAST INDIANA AMBULATORY SURGERY CENTER

Facility Address:
11277 TWIN CREEKS DRIVE
FORT WAYNE, IN
ZIP 46845
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Facility Phone Number: 260 414-9117

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1811941024

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	15D2266118
LAB Type	Ambulatory Surgery Center
Facility Name	NORTHEAST INDIANA AMBULATORY SURGERY CENTER
Street	11277 TWIN CREEKS DRIVE
City	FORT WAYNE
State	IN
ZIP	46845
Phone	260 414-9117
CertificateType	4
CertificateEffectiveDate	8/5/2022
CertificateExpirationDate	8/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024