36D1005942 CLIA NUMBER - VALLEY MEDICAL PRIMARY CARE

Laboratory Demographics

CLIA Number: 36D1005942

Facility Name: VALLEY MEDICAL PRIMARY CARE

Facility Address:
6611 CLYO RD STE E
CENTERVILLE, OH
ZIP 45459
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Facility Phone Number: 937 208-8282

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1528127610

Taxonomy: 207RG0300X - Internal Medicine
An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital.

CLIA Record

Field Name	Field Value
CLIA Number	36D1005942
LAB Type	Physician Office
Facility Name	VALLEY MEDICAL PRIMARY CARE
Street	6611 CLYO RD STE E
City	CENTERVILLE
State	OH
ZIP	45459
Phone	937 208-8282
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024