36D0331468 CLIA NUMBER - PROMEDICA PHYSICIANS PERRYSBURG PEDIATRICS

Laboratory Demographics

  • CLIA Code: 36D0331468
  • Facility Name: PROMEDICA PHYSICIANS PERRYSBURG PEDIATRICS
  • Facility Address: 1620 BRIGHAM DRIVE, SUITE 240
    PERRYSBURG, OH
    ZIP 43551
  • Facility Phone: 419 872-7700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JON DVORAK
  • NPI Number: 1053455170
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 36D0331468
LAB Type Physician Office
Facility Name PROMEDICA PHYSICIANS PERRYSBURG PEDIATRICS
Street 1620 BRIGHAM DRIVE, SUITE 240
City PERRYSBURG
State OH
ZIP 43551
Phone 419 872-7700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2025
Certificate Expiration Date 8/9/2027
Facility Type Physician Office
Lab Director JON DVORAK

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This page was last updated on: 9/29/2025