15D2315648 CLIA NUMBER - BEACON MEDICAL GROUP UROLOGY GOSHEN

Laboratory Demographics

  • CLIA Code: 15D2315648
  • Facility Name: BEACON MEDICAL GROUP UROLOGY GOSHEN
  • Facility Address: 1302 COLLEGE AVE, STE 2
    GOSHEN, IN
    ZIP 46526
  • Facility Phone: 574 206-0380
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANISH H. NAYEE
  • NPI Number: 1306863915
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 15D2315648
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP UROLOGY GOSHEN
Street 1302 COLLEGE AVE, STE 2
City GOSHEN
State IN
ZIP 46526
Phone 574 206-0380
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Physician Office
Lab Director ANISH H. NAYEE

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