15D2281931 CLIA NUMBER - BEACON MEDICAL GROUP MISHAWAKA

Laboratory Demographics

  • CLIA Code: 15D2281931
  • Facility Name: BEACON MEDICAL GROUP MISHAWAKA
  • Facility Address: 5314 LINCOLNWAY EAST
    MISHAWAKA, IN
    ZIP 46544
  • Facility Phone: 574 584-2812
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DALE PATTERSON
  • NPI Number: 1275550899
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2281931
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP MISHAWAKA
Street 5314 LINCOLNWAY EAST
City MISHAWAKA
State IN
ZIP 46544
Phone 574 584-2812
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2025
Certificate Expiration Date 5/14/2027
Facility Type Physician Office
Lab Director DALE PATTERSON

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