36D0331445 CLIA NUMBER - PROMEDICA PHYSICIANS RIVER ROAD FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 36D0331445

Facility Name: PROMEDICA PHYSICIANS RIVER ROAD FAMILY MEDICINE

Facility Address:
1601 BRIGHAM DRIVE SUITE 250
PERRYSBURG, OH
ZIP 43551
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Facility Phone Number: 419 872-7743

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1285826156

Taxonomy: 207V00000X - Obstetrics & Gynecology
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

CLIA Record

Field Name	Field Value
CLIA Number	36D0331445
LAB Type	Physician Office
Facility Name	PROMEDICA PHYSICIANS RIVER ROAD FAMILY MEDICINE
Street	1601 BRIGHAM DRIVE SUITE 250
City	PERRYSBURG
State	OH
ZIP	43551
Phone	419 872-7743
CertificateType	4
CertificateEffectiveDate	12/2/2022
CertificateExpirationDate	12/1/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024