36D0856658 CLIA NUMBER - MOUNT CARMEL STREET MEDICINE

Laboratory Demographics

  • CLIA Code: 36D0856658
  • Facility Name: MOUNT CARMEL STREET MEDICINE
  • Facility Address: 777 W STATE ST SUITE 125
    COLUMBUS, OH
    ZIP 43222
  • Facility Phone: 614 234-4718
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: RYAN M. CANTZLER
  • NPI Number: 1922130715
  • Taxonomy: 225X00000X - Occupational Therapist

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CLIA Record

Field Name Field Value
CLIA Number 36D0856658
LAB Type Mobile Laboratory
Facility Name MOUNT CARMEL STREET MEDICINE
Street 777 W STATE ST SUITE 125
City COLUMBUS
State OH
ZIP 43222
Phone 614 234-4718
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2024
Certificate Expiration Date 3/9/2026
Facility Type Mobile Laboratory
Lab Director RYAN M. CANTZLER

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