15D2299039 CLIA NUMBER - PRIVIA MEDICAL GROUP INDIANA, LLC

Laboratory Demographics

  • CLIA Code: 15D2299039
  • Facility Name: PRIVIA MEDICAL GROUP INDIANA, LLC
  • Facility Address: 6915 N FIR RD
    GRANGER, IN
    ZIP 46530
  • Facility Phone: 574 296-3368
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMER KAZI
  • NPI Number: 1689440893
  • Taxonomy: 2084P2900X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 15D2299039
LAB Type Physician Office
Facility Name PRIVIA MEDICAL GROUP INDIANA, LLC
Street 6915 N FIR RD
City GRANGER
State IN
ZIP 46530
Phone 574 296-3368
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2024
Certificate Expiration Date 2/12/2026
Facility Type Physician Office
Lab Director AMER KAZI

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