36D0714330 CLIA NUMBER - GREG A WISE MD INC

Laboratory Demographics

  • CLIA Code: 36D0714330
  • Facility Name: GREG A WISE MD INC
  • Facility Address: 4100 VENTURE PL
    GROVEPORT, OH
    ZIP 43125
  • Facility Phone: 614 836-2273
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GREG A. WISE MD
  • NPI Number: 1366413940
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0714330
LAB Type Physician Office
Facility Name GREG A WISE MD INC
Street 4100 VENTURE PL
City GROVEPORT
State OH
ZIP 43125
Phone 614 836-2273
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 GREG A. WISE MD

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