15D2279989 CLIA NUMBER - EVERSIDE HEALTH-LAGRANGE PHS

Laboratory Demographics

CLIA Number: 15D2279989

Facility Name: EVERSIDE HEALTH-LAGRANGE PHS

Facility Address:
0305 S 1150 E
LAGRANGE, IN
ZIP 46761
Get Directions

Facility Phone Number: 260 766-6190

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1356947535

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2279989
LAB Type	Physician Office
Facility Name	EVERSIDE HEALTH-LAGRANGE PHS
Street	0305 S 1150 E
City	LAGRANGE
State	IN
ZIP	46761
Phone	260 766-6190
CertificateType	4
CertificateEffectiveDate	4/11/2023
CertificateExpirationDate	4/10/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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