15D2316729 CLIA NUMBER - FORT WAYNE DIRECT PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 15D2316729
  • Facility Name: FORT WAYNE DIRECT PRIMARY CARE
  • Facility Address: 4630 W JEFFERSON BLVD, SUITE-8
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 264-9337
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KALYAN C. ALURI
  • NPI Number: 1497758429
  • Taxonomy: 207X00000X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 15D2316729
LAB Type Physician Office
Facility Name FORT WAYNE DIRECT PRIMARY CARE
Street 4630 W JEFFERSON BLVD, SUITE-8
City FORT WAYNE
State IN
ZIP 46804
Phone 260 264-9337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2025
Certificate Expiration Date 1/9/2027
Facility Type Physician Office
Lab Director KALYAN C. ALURI

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