15D2284566 CLIA NUMBER - BOLDAGE PACE EVANSVILLE

Laboratory Demographics

CLIA Code: 15D2284566
Facility Name: BOLDAGE PACE EVANSVILLE
Facility Address: 700 E WALNUT ST
EVANSVILLE, IN
ZIP 47713
Facility Phone: 812 213-4235
Facility Type: Community Clinic
Facility Type: Waiver
Lab Director: TONI HIVELY
NPI Number: 1407543960
Taxonomy: 251T00000X - Program of All-Inclusive Care for the Elderly (PACE) Provider Organization

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CLIA Record

Field Name	Field Value
CLIA Number	15D2284566
LAB Type	Community Clinic
Facility Name	BOLDAGE PACE EVANSVILLE
Street	700 E WALNUT ST
City	EVANSVILLE
State	IN
ZIP	47713
Phone	812 213-4235
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	6/26/2025
Certificate Expiration Date	6/25/2027
Facility Type	Community Clinic
Lab Director	TONI HIVELY

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