36D0708007 CLIA NUMBER - PROMEDICA PHYSICIANS FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 36D0708007
  • Facility Name: PROMEDICA PHYSICIANS FAMILY MEDICINE
  • Facility Address: 1990 COUNTY ROAD U
    METAMORA, OH
    ZIP 43540
  • Facility Phone: 419 644-4818
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN C. EVANOFF
  • NPI Number: 1922142447
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0708007
LAB Type Physician Office
Facility Name PROMEDICA PHYSICIANS FAMILY MEDICINE
Street 1990 COUNTY ROAD U
City METAMORA
State OH
ZIP 43540
Phone 419 644-4818
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2025
Certificate Expiration Date 7/9/2027
Facility Type Physician Office
Lab Director JOHN C. EVANOFF

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