15D2323456 CLIA NUMBER - VISIONARY SURGERY CENTER, LLC

Laboratory Demographics

  • CLIA Code: 15D2323456
  • Facility Name: VISIONARY SURGERY CENTER, LLC
  • Facility Address: 4335 EDISON LAKES PKWY
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 610 248-7787
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ANN K. WIARDA
  • NPI Number: 1821810326
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2323456
LAB Type Ambulatory Surgery Center
Facility Name VISIONARY SURGERY CENTER, LLC
Street 4335 EDISON LAKES PKWY
City MISHAWAKA
State IN
ZIP 46545
Phone 610 248-7787
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2025
Certificate Expiration Date 5/6/2027
Facility Type Ambulatory Surgery Center
Lab Director ANN K. WIARDA

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