15D2297084 CLIA NUMBER - BOWEN HEALTH CLINIC - GOSHEN RO

Laboratory Demographics

  • CLIA Code: 15D2297084
  • Facility Name: BOWEN HEALTH CLINIC - GOSHEN RO
  • Facility Address: 2100 GOSHEN ROAD
    FORT WAYNE, IN
    ZIP 46808
  • Facility Phone: 574 371-9532
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: TODD A. HIMES
  • NPI Number: 1386159176
  • Taxonomy: 261QM2800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2297084
LAB Type Federally Qualified Health Center
Facility Name BOWEN HEALTH CLINIC - GOSHEN RO
Street 2100 GOSHEN ROAD
City FORT WAYNE
State IN
ZIP 46808
Phone 574 371-9532
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2024
Certificate Expiration Date 1/9/2026
Facility Type Federally Qualified Health Center
Lab Director TODD A. HIMES

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