15D2305219 CLIA NUMBER - BHG LXVII, LLC D/B/A BHG MEDICAL SERVICES - INDIANA

Laboratory Demographics

  • CLIA Code: 15D2305219
  • Facility Name: BHG LXVII, LLC D/B/A BHG MEDICAL SERVICES - INDIANA
  • Facility Address: 3910 LIMA ROAD, OBOT ROOM #100
    FORT WAYNE, IN
    ZIP 46805
  • Facility Phone: 260 420-6010
  • Facility Type: Other - OFFICE BASED OPIOID TREAT
  • Facility Type: Waiver
  • Lab Director: MICHELLE NESTLEROAD
  • NPI Number: 1275316697
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2305219
LAB Type Other - OFFICE BASED OPIOID TREAT
Facility Name BHG LXVII, LLC D/B/A BHG MEDICAL SERVICES - INDIANA
Street 3910 LIMA ROAD, OBOT ROOM #100
City FORT WAYNE
State IN
ZIP 46805
Phone 260 420-6010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/28/2024
Certificate Expiration Date 5/27/2026
Facility Type Other - OFFICE BASED OPIOID TREAT
Lab Director MICHELLE NESTLEROAD

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