15D2294080 CLIA NUMBER - WILLOW OAK MEDICAL, LLC

Laboratory Demographics

  • CLIA Code: 15D2294080
  • Facility Name: WILLOW OAK MEDICAL, LLC
  • Facility Address: 100 S MAIN STREET
    CLINTON, IN
    ZIP 47842
  • Facility Phone: 765 505-5200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEANIE M. KENT
  • NPI Number: 1366224719
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2294080
LAB Type Physician Office
Facility Name WILLOW OAK MEDICAL, LLC
Street 100 S MAIN STREET
City CLINTON
State IN
ZIP 47842
Phone 765 505-5200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/17/2023
Certificate Expiration Date 11/16/2025
Facility Type Physician Office
Lab Director JEANIE M. KENT

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