15D2279989 CLIA NUMBER - EVERSIDE HEALTH-LAGRANGE PHS

Laboratory Demographics

  • CLIA Code: 15D2279989
  • Facility Name: EVERSIDE HEALTH-LAGRANGE PHS
  • Facility Address: 0305 S 1150 E
    LAGRANGE, IN
    ZIP 46761
  • Facility Phone: 260 766-6190
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBIN BRAUCHLA
  • NPI Number: 1356947535
  • Taxonomy: 261QH0100X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/11/2025
Certificate Expiration Date 4/10/2027
Facility Type Physician Office
Lab Director ROBIN BRAUCHLA

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