36D0957201 CLIA NUMBER - LICKING MEMORIAL FAMILY PRACTICE LICKING VALLEY

Laboratory Demographics

  • CLIA Code: 36D0957201
  • Facility Name: LICKING MEMORIAL FAMILY PRACTICE LICKING VALLEY
  • Facility Address: 2181 W HIGH STREET
    NEWARK, OH
    ZIP 43055
  • Facility Phone: 740 348-1720
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREW C. SEIPEL
  • NPI Number: 1013935865
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0957201
LAB Type Physician Office
Facility Name LICKING MEMORIAL FAMILY PRACTICE LICKING VALLEY
Street 2181 W HIGH STREET
City NEWARK
State OH
ZIP 43055
Phone 740 348-1720
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Physician Office
Lab Director ANDREW C. SEIPEL

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