36D0941912 CLIA NUMBER - PRIMED PHYSICIANS PATTERSON WOODS FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 36D0941912
  • Facility Name: PRIMED PHYSICIANS PATTERSON WOODS FAMILY PRACTICE
  • Facility Address: 1900 COMPOSITE DRIVE
    KETTERING, OH
    ZIP 45420
  • Facility Phone: 937 293-8419
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WILLIAM J. RANDALL
  • NPI Number: 1285690339
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0941912
LAB Type Physician Office
Facility Name PRIMED PHYSICIANS PATTERSON WOODS FAMILY PRACTICE
Street 1900 COMPOSITE DRIVE
City KETTERING
State OH
ZIP 45420
Phone 937 293-8419
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2025
Certificate Expiration Date 6/14/2027
Facility Type Physician Office
Lab Director WILLIAM J. RANDALL

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