36D0349656 CLIA NUMBER - INTERNAL MEDICINE & PEDIATRICS OF CENTERVILLE

Laboratory Demographics

  • CLIA Code: 36D0349656
  • Facility Name: INTERNAL MEDICINE & PEDIATRICS OF CENTERVILLE
  • Facility Address: 6611 CLYO RD STE A
    CENTERVILLE, OH
    ZIP 45459
  • Facility Phone: 937 208-7300
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MICKEY E. DENEN MD
  • NPI Number: 1154376242
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0349656
LAB Type Physician Office
Facility Name INTERNAL MEDICINE & PEDIATRICS OF CENTERVILLE
Street 6611 CLYO RD STE A
City CENTERVILLE
State OH
ZIP 45459
Phone 937 208-7300
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 7/17/2024
Certificate Expiration Date 7/16/2026
Facility Type Physician Office
Lab Director MICKEY E. DENEN MD

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