15D2267651 CLIA NUMBER - BEACON MEDICAL GROUP PULMONOLOGY AND CRITICAL CARE SOUTH BEND

Laboratory Demographics

  • CLIA Code: 15D2267651
  • Facility Name: BEACON MEDICAL GROUP PULMONOLOGY AND CRITICAL CARE SOUTH BEND
  • Facility Address: 621 MEMORIAL DRIVE, SUITE 302
    SOUTH BEND, IN
    ZIP 46601
  • Facility Phone: 574 246-9350
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW KOSCIELSKI
  • NPI Number: 1831149525
  • Taxonomy: 207X00000X - Orthopaedic Surgery

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2267651
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP PULMONOLOGY AND CRITICAL CARE SOUTH BEND
Street 621 MEMORIAL DRIVE, SUITE 302
City SOUTH BEND
State IN
ZIP 46601
Phone 574 246-9350
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/29/2024
Certificate Expiration Date 8/28/2026
Facility Type Physician Office
Lab Director MATTHEW KOSCIELSKI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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