15D2313460 CLIA NUMBER - DEACONESS SPECIALITY PHYSICIANS, INC/NE MOB2 GATEWAY

Laboratory Demographics

  • CLIA Code: 15D2313460
  • Facility Name: DEACONESS SPECIALITY PHYSICIANS, INC/NE MOB2 GATEWAY
  • Facility Address: 4209 GATEWAY BLVD, SUITE 2100
    NEWBURGH, IN
    ZIP 47630
  • Facility Phone: (812) 492-5202
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NAROTHAMA R. AEDDULA
  • NPI Number: 1306418405
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2313460
LAB Type Physician Office
Facility Name DEACONESS SPECIALITY PHYSICIANS, INC/NE MOB2 GATEWAY
Street 4209 GATEWAY BLVD, SUITE 2100
City NEWBURGH
State IN
ZIP 47630
Phone 8124925202
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Physician Office
Lab Director NAROTHAMA R. AEDDULA

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This page was last updated on: 5/18/2026