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CONNECTION MEDICAL CLINIC
NPI 1306453626
Clinic/Center - Primary Care in Demotte, IN

Active since September 30, 2020CLIA 15D2223405 · Waiver
1317 15TH ST. SE, DEMOTTE, IN 46310(219) 987-4280 Get Directions Write a Review

NPPES record last updated: February 26, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Feb 26, 2021, Sep 30, 2020 (2 updates tracked since 2020).

About Connection Medical Clinic NPPES

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

CONNECTION MEDICAL CLINIC (NPI 1306453626) is a healthcare organization registered as a primary care in Demotte, Indiana and active in the NPI registry since September 2020. The organization holds a CLIA Waiver certificate valid through May 5, 2027 and lists James Clark, President, as its authorized official.

NPPES Registry Identity

NPI1306453626
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameCALVARY ASSEMBLY OF GOD
Location Address1317 15TH ST. SEDemotte, IN 46310-9393
Mailing Address1317 15th St SeDemotte, IN 46310 · (219) 987-4280
Phone(219) 987-4280
Organization SubpartNo
Authorized OfficialJames ClarkPresident · (219) 987-4280
Enumeration DateSeptember 30, 2020
Last NPPES UpdateFebruary 26, 20212 updates tracked since enumeration
NPPES CertifiedFebruary 26, 2021
✔ NPI 1306453626 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
1317 15TH ST. SE, Demotte, IN 46310
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Other Names 1

Doing Business AsConnection Medical Clinic

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 15D2223405

Connection Medical Clinic · Demotte, IN
Active · expires May 5, 2027
CLIA Number15D2223405
Laboratory TypePractitioner Other
Certificate Effective DateMay 6, 2025
Certificate Expiration DateMay 5, 2027
Laboratory DirectorDesiree E. Samples
Laboratory Phone(219) 270-3358
Laboratory LocationConnection Medical Clinic1317 15th St SE, Demotte, IN 46310
CLIA data matches this NPI record on: Address Name
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 Calvary Assembly Of God's NPI number?

The NPI number for Calvary Assembly Of God is 1306453626. It was assigned to this organization in the NPPES registry on September 30, 2020. The provider is doing business as Connection Medical Clinic.

Where is Calvary Assembly Of God located?

Calvary Assembly Of God is located at 1317 15th St. SE, Demotte, IN 46310. The listed phone number is (219) 987-4280.

What is Calvary Assembly Of God's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Calvary Assembly Of God hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2223405) is associated with this NPI, valid through May 5, 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 Calvary Assembly Of God was last updated on February 26, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.