36D0980226 CLIA NUMBER - LICKING MEMORIAL FAMILY PRACTICE JOHNSTOWN

Laboratory Demographics

  • CLIA Code: 36D0980226
  • Facility Name: LICKING MEMORIAL FAMILY PRACTICE JOHNSTOWN
  • Facility Address: 151 WOODGATE DRIVE
    JOHNSTOWN, OH
    ZIP 43031
  • Facility Phone: 740 348-1810
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ELIZABETH MCINTOSH
  • NPI Number: 1255365102
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0980226
LAB Type Physician Office
Facility Name LICKING MEMORIAL FAMILY PRACTICE JOHNSTOWN
Street 151 WOODGATE DRIVE
City JOHNSTOWN
State OH
ZIP 43031
Phone 740 348-1810
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2024
Certificate Expiration Date 4/30/2026
Facility Type Physician Office
Lab Director ELIZABETH MCINTOSH

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