36D0987961 CLIA NUMBER - LICKING MEMORIAL FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 36D0987961
  • Facility Name: LICKING MEMORIAL FAMILY PRACTICE
  • Facility Address: ONE HEALTHY PLACE SUITE 201
    PATASKALA, OH
    ZIP 43062
  • Facility Phone: 740 348-1906
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: COLLEEN SMITH
  • NPI Number: 1851325526
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D0987961
LAB Type Physician Office
Facility Name LICKING MEMORIAL FAMILY PRACTICE
Street ONE HEALTHY PLACE SUITE 201
City PATASKALA
State OH
ZIP 43062
Phone 740 348-1906
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/22/2024
Certificate Expiration Date 7/21/2026
Facility Type Physician Office
Lab Director COLLEEN SMITH

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