15D2268801 CLIA NUMBER - FORT WAYNE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 15D2268801
  • Facility Name: FORT WAYNE PRIMARY CARE
  • Facility Address: 7802 WEST JEFFERSON SUITE A
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 999-6924
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VISHAAL VEERULA
  • NPI Number: 1528707619
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2268801
LAB Type Physician Office
Facility Name FORT WAYNE PRIMARY CARE
Street 7802 WEST JEFFERSON SUITE A
City FORT WAYNE
State IN
ZIP 46804
Phone 260 999-6924
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Physician Office
Lab Director VISHAAL VEERULA

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