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BLACKBIRD CLINICAL SERVICES, LLC
NPI 1164669255
Public Health or Welfare in Lafayette, IN

Active since January 12, 2009CLIA 15D2051590 · Waiver
2 EXECUTIVE DR STE D, LAFAYETTE, IN 47905(765) 447-8700 Get Directions Write a Review

NPPES record last updated: January 12, 2009. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Blackbird Clinical Services, Llc NPPES

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

BLACKBIRD CLINICAL SERVICES, LLC (NPI 1164669255) is a healthcare organization registered as a public health or welfare in Lafayette, Indiana and active in the NPI registry since January 2009. The organization holds a CLIA Waiver certificate valid through July 29, 2027 and lists Kimi L. Hathaway, President/ Ceo, as its authorized official.

NPPES Registry Identity

NPI1164669255
Entity TypeOrganization
Primary Taxonomy251K00000X
Legal Business NameBLACKBIRD CLINICAL SERVICES, LLC
Location Address2 EXECUTIVE DR STE DLafayette, IN 47905-4878
Mailing Address2 Executive Dr Ste DLafayette, IN 47905-4878 · (765) 447-8700
Phone(765) 447-8700
Organization SubpartNo
Authorized OfficialKimi L. HathawayPresident/ Ceo · (765) 447-8700
Enumeration DateJanuary 12, 2009
✔ NPI 1164669255 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPublic Health or WelfareAgencies
Taxonomy Code251K00000X
2 EXECUTIVE DR STE D, Lafayette, IN 47905
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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 15D2051590

Blackbird Clinical Services · Lafayette, IN
Active · expires Jul 29, 2027
CLIA Number15D2051590
Laboratory TypeMobile Laboratory
Certificate Effective DateJuly 30, 2025
Certificate Expiration DateJuly 29, 2027
Laboratory DirectorKimi L. Hathaway
Laboratory Phone(765) 447-8700
Laboratory LocationBlackbird Clinical Services2 Executive Drive, Ste D, Lafayette, IN 47905
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Blackbird Clinical Services, LLC's NPI number?

The NPI number for Blackbird Clinical Services, LLC is 1164669255. It was assigned to this organization in the NPPES registry on January 12, 2009.

Where is Blackbird Clinical Services, LLC located?

Blackbird Clinical Services, LLC is located at 2 Executive Dr Ste D, Lafayette, IN 47905. The listed phone number is (765) 447-8700.

What is Blackbird Clinical Services, LLC's specialty?

The primary specialty registered for this NPI is Public Health or Welfare with taxonomy code 251K00000X.

Does Blackbird Clinical Services, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2051590) is associated with this NPI, valid through July 29, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Blackbird Clinical Services, LLC was last updated on January 12, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years 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.