36D0887692 CLIA NUMBER - GREAT TRAIL FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 36D0887692
  • Facility Name: GREAT TRAIL FAMILY PRACTICE
  • Facility Address: 1028 EAST LINCOLNWAY
    MINERVA, OH
    ZIP 44657
  • Facility Phone: 330 868-6044
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: EDWARD N. BARR
  • NPI Number: 1609957901
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 36D0887692
LAB Type Physician Office
Facility Name GREAT TRAIL FAMILY PRACTICE
Street 1028 EAST LINCOLNWAY
City MINERVA
State OH
ZIP 44657
Phone 330 868-6044
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 6/16/2024
Certificate Expiration Date 6/15/2026
Facility Type Physician Office
Lab Director EDWARD N. BARR

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