36D0966788 CLIA NUMBER - KETTERING HEALTH MEDICAL GROUP PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 36D0966788
  • Facility Name: KETTERING HEALTH MEDICAL GROUP PRIMARY CARE
  • Facility Address: 5964 GOLF CLUB LN
    FAIRFIELD, OH
    ZIP 45011
  • Facility Phone: 513 893-1100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DENNIS ANTHONY
  • NPI Number: 1548621311
  • Taxonomy: 207X00000X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 36D0966788
LAB Type Physician Office
Facility Name KETTERING HEALTH MEDICAL GROUP PRIMARY CARE
Street 5964 GOLF CLUB LN
City FAIRFIELD
State OH
ZIP 45011
Phone 513 893-1100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2025
Certificate Expiration Date 7/26/2027
Facility Type Physician Office
Lab Director DENNIS ANTHONY

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