36D0701796 CLIA NUMBER - JACKSON FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 36D0701796
  • Facility Name: JACKSON FAMILY PRACTICE
  • Facility Address: 7072 MEARS GATE DRIVE NW
    NORTH CANTON, OH
    ZIP 44720
  • Facility Phone: 330 966-1319
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: STAN R. ANDERSON MD
  • NPI Number: 1699881581
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0701796
LAB Type Physician Office
Facility Name JACKSON FAMILY PRACTICE
Street 7072 MEARS GATE DRIVE NW
City NORTH CANTON
State OH
ZIP 44720
Phone 330 966-1319
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 4/22/2024
Certificate Expiration Date 4/21/2026
Facility Type Physician Office
Lab Director STAN R. ANDERSON MD

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