15D2314043 CLIA NUMBER - CHARLESTOWN COMMUNITY MEDICAL

Laboratory Demographics

  • CLIA Code: 15D2314043
  • Facility Name: CHARLESTOWN COMMUNITY MEDICAL
  • Facility Address: 890 MAIN ST
    CHARLESTOWN, IN
    ZIP 47111
  • Facility Phone: 812 280-2080
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: AMANDA DAVIS-HOUCHEN
  • NPI Number: 1114108164
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2314043
LAB Type Federally Qualified Health Center
Facility Name CHARLESTOWN COMMUNITY MEDICAL
Street 890 MAIN ST
City CHARLESTOWN
State IN
ZIP 47111
Phone 812 280-2080
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2024
Certificate Expiration Date 11/11/2026
Facility Type Federally Qualified Health Center
Lab Director AMANDA DAVIS-HOUCHEN

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