OXYGEN MEDICAL DIAGNOSTIC LAB
NPI 1104763895
Pathology - Clinical Laboratory Director, Non-physician in Merrillville, IN
NPI Status: Active since April 30, 2026
Contact Information
8300 BROADWAY STE D2
MERRILLVILLE, IN
ZIP 46410
Phone: (219) 306-0674
- Organization
- Pathology
- Clinical Laboratory Director, Non-physic...
- CLIA Number: 15D2341602
- CLIA Cert. Type: Mobile Laboratory
- CLIA Exp. Date: 04-05-2028
About OXYGEN MEDICAL DIAGNOSTIC LAB
This page provides the complete NPI Profile along with additional information for Oxygen Medical Diagnostic Lab, a provider established in Merrillville, Indiana operating as a Pathology, focusing in clinical laboratory director, non-physician . The healthcare provider is registered in the NPI registry with number 1104763895 assigned on April 2026. The practitioner's primary taxonomy code is 247ZC0005X. The provider is registered as an organization and their NPI record was last updated April 2026. Oxygen Medical Diagnostic Lab operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Regina M Etim Healthcare Specialis (Ceo)
- NPI
- 1104763895
- Provider Name
- OXYGEN MEDICAL DIAGNOSTIC LAB
- Entity Type
- Organization
- Location Address
- 8300 BROADWAY STE D2 MERRILLVILLE, IN 46410
- Location Phone
- (219) 306-0674
- Mailing Address
- 8300 BROADWAY STE D2 MERRILLVILLE, IN 46410
- Mailing Phone
- (219) 306-0674
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-30-2026
- Last Update Date
- 04-30-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pathology Clinical Laboratory Director, Non-physician
- Taxonomy Code
- 247ZC0005X
- Type
- Technologists, Technicians & Other Technical Service Providers
- Taxonomy Description
- 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.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 15D2341602
- Facility Type
- Mobile Laboratory
- Certificate Effective Date
- April 06, 2026
- Certificate Expiration Date
- April 05, 2028
- Laboratory Director
- REGINA M. ETIM
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Oxygen Medical Diagnostic Lab to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104763895, we treat the final digit (5) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 65. The final step is to find the difference between that total and the next multiple of ten (70 - 65 = 5).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 65 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 2 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104763895, enumerated as an "organization" on April 30, 2026.
The provider is located at 8300 BROADWAY STE D2 MERRILLVILLE, IN 46410 and the phone number is (219) 306-0674.
Pathology with taxonomy code 247ZC0005X and a focus in Clinical Laboratory Director, Non-physician.
