15D2325559 CLIA NUMBER - BEACON MEDICAL GROUP MATERNAL FETAL MEDICINE SOUTH BEND

Laboratory Demographics

  • CLIA Code: 15D2325559
  • Facility Name: BEACON MEDICAL GROUP MATERNAL FETAL MEDICINE SOUTH BEND
  • Facility Address: 621 MEMORIAL DR, STE 403
    SOUTH BEND, IN
    ZIP 46601
  • Facility Phone: 574 647-6370
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DALE PATTERSON
  • NPI Number: 1710939608
  • Taxonomy: 207VM0101X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 15D2325559
LAB Type Physician Office
Facility Name BEACON MEDICAL GROUP MATERNAL FETAL MEDICINE SOUTH BEND
Street 621 MEMORIAL DR, STE 403
City SOUTH BEND
State IN
ZIP 46601
Phone 574 647-6370
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/16/2025
Certificate Expiration Date 6/15/2027
Facility Type Physician Office
Lab Director DALE PATTERSON

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