33D2192448 CLIA NUMBER - INDIAN LAKE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 33D2192448
  • Facility Name: INDIAN LAKE HEALTH CENTER
  • Facility Address: 6356 NYS RTE 30
    INDIAN LAKE, NY
    ZIP 12842
  • Facility Phone: 518 648-5707
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. KEVIN A. GALLAGHER
  • NPI Number: 1841344017
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 33D2192448
LAB Type Federally Qualified Health Center
Facility Name INDIAN LAKE HEALTH CENTER
Street 6356 NYS RTE 30
City INDIAN LAKE
State NY
ZIP 12842
Phone 518 648-5707
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/10/2020
Certificate Expiration Date 3/26/2027
Facility Type Federally Qualified Health Center
Lab Director DR. KEVIN A. GALLAGHER

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