36D0349520 CLIA NUMBER - MAIN STREET FAMILY PRACTICE INC

Laboratory Demographics

  • CLIA Code: 36D0349520
  • Facility Name: MAIN STREET FAMILY PRACTICE INC
  • Facility Address: 9000 N MAIN STREET SUITE 403
    DAYTON, OH
    ZIP 45415
  • Facility Phone: 937 836-5171
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARTIN K. FUJIMARA
  • NPI Number: 1093864035
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0349520
LAB Type Physician Office
Facility Name MAIN STREET FAMILY PRACTICE INC
Street 9000 N MAIN STREET SUITE 403
City DAYTON
State OH
ZIP 45415
Phone 937 836-5171
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MARTIN K. FUJIMARA

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