15D2299806 CLIA NUMBER - MARATHON HEALTH EAST BLOOMINGTON

Laboratory Demographics

  • CLIA Code: 15D2299806
  • Facility Name: MARATHON HEALTH EAST BLOOMINGTON
  • Facility Address: 121 N PETE ELLIS DRIVE, SUITE 102
    BLOOMINGTON, IN
    ZIP 47408
  • Facility Phone: 802 857-0400
  • Facility Type: Other - ONSITE HEALTH CENTER
  • Facility Type: Waiver
  • Lab Director: REBECCA GUANAJUATO
  • NPI Number: 1194358168
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 15D2299806
LAB Type Other - ONSITE HEALTH CENTER
Facility Name MARATHON HEALTH EAST BLOOMINGTON
Street 121 N PETE ELLIS DRIVE, SUITE 102
City BLOOMINGTON
State IN
ZIP 47408
Phone 802 857-0400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Other - ONSITE HEALTH CENTER
Lab Director REBECCA GUANAJUATO

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