1. Home
  2. Directory
  3. Indiana
  4. Merrillville
  5. Pathology
  6. NPI Profile

OXYGEN MEDICAL DIAGNOSTIC LAB
NPI 1104763895
Pathology - Clinical Laboratory Director, Non-physician in Merrillville, IN

Active since April 30, 2026CLIA 15D2341602 · Waiver
8300 BROADWAY STE D2, MERRILLVILLE, IN 46410(219) 306-0674 Get Directions Write a Review

NPPES record last updated: April 30, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Oxygen Medical Diagnostic Lab NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OXYGEN MEDICAL DIAGNOSTIC LAB (NPI 1104763895) is a healthcare organization registered as a clinical laboratory director, non-physician in Merrillville, Indiana and active in the NPI registry since April 2026. The organization holds a CLIA Waiver certificate valid through April 5, 2028 and lists Regina M Etim, Ceo, as its authorized official.

NPPES Registry Identity

NPI1104763895
Entity TypeOrganization
Primary Taxonomy247ZC0005X
Legal Business NameOXYGEN MEDICAL DIAGNOSTIC LAB
Location Address8300 BROADWAY STE D2Merrillville, IN 46410-8603
Mailing Address8300 Broadway Ste D2Merrillville, IN 46410-8603 · (219) 306-0674
Phone(219) 306-0674
Organization SubpartNo
Authorized OfficialRegina M EtimCeo · (219) 306-0674
Enumeration DateApril 30, 2026
NPPES CertifiedApril 30, 2026
✔ NPI 1104763895 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPathology · Clinical Laboratory Director, Non-physicianTechnologists, Technicians & Other Technical Service Providers
Taxonomy Code247ZC0005X
Definition
An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405.
8300 BROADWAY STE D2, Merrillville, IN 46410
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2341602

Oxygen Medical Diagnostic Labs · Merrillville, IN
Active · expires Apr 5, 2028
CLIA Number15D2341602
Laboratory TypeMobile Laboratory
Certificate Effective DateApril 6, 2026
Certificate Expiration DateApril 5, 2028
Laboratory DirectorRegina M. Etim
Laboratory Phone(219) 306-0674
Laboratory LocationOxygen Medical Diagnostic Labs8300 Broadway Unit D2, Merrillville, IN 46410
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHANN DAVID FARLEY MD
Family Medicine
8300 BROADWAY STE D2
MERRILLVILLE, IN 46410
Lake County (219) 649-0044
JOHANN FARLEY MD PC
Clinic/Center (Primary Care)
8300 BROADWAY STE D2
MERRILLVILLE, IN 46410
Lake County (219) 649-0044

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Oxygen Medical Diagnostic Lab's NPI number?

The NPI number for Oxygen Medical Diagnostic Lab is 1104763895. It was assigned to this organization in the NPPES registry on April 30, 2026.

Where is Oxygen Medical Diagnostic Lab located?

Oxygen Medical Diagnostic Lab is located at 8300 Broadway Ste D2, Merrillville, IN 46410. The listed phone number is (219) 306-0674.

What is Oxygen Medical Diagnostic Lab's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Clinical Laboratory Director, Non-physician, with taxonomy code 247ZC0005X.

Does Oxygen Medical Diagnostic Lab hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2341602) is associated with this NPI, valid through April 5, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Oxygen Medical Diagnostic Lab was last updated on April 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.