39D1063107 CLIA NUMBER - INDIANA CARE NETWORK

Laboratory Demographics

  • CLIA Code: 39D1063107
  • Facility Name: INDIANA CARE NETWORK
  • Facility Address: 802 MCKINLEY STREET
    BOLIVAR, PA
    ZIP 15923
  • Facility Phone: 724 676-4709
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. PATRICK R. SHANNON
  • NPI Number: 1912781063
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 39D1063107
LAB Type Physician Office
Facility Name INDIANA CARE NETWORK
Street 802 MCKINLEY STREET
City BOLIVAR
State PA
ZIP 15923
Phone 724 676-4709
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/5/2025
Certificate Expiration Date 1/4/2027
Facility Type Physician Office
Lab Director DR. PATRICK R. SHANNON

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