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36D1006354 CLIA NUMBER - PREMIER CARDIOVASCULAR INSTITUTE

Laboratory Demographics

CLIA Number: 36D1006354

Facility Name: PREMIER CARDIOVASCULAR INSTITUTE

Facility Address:
122 WYOMING STREET SUITE 100
DAYTON, OH
ZIP 45409
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Facility Phone Number: 937 341-6767

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1811944531

Taxonomy: 208G00000X - Thoracic Surgery (Cardiothoracic Vascular Surgery)
A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty.

CLIA Record

Field Name Field Value
CLIA Number 36D1006354
LAB Type Physician Office
Facility Name PREMIER CARDIOVASCULAR INSTITUTE
Street 122 WYOMING STREET SUITE 100
City DAYTON
State OH
ZIP 45409
Phone 937 341-6767
CertificateType 4
CertificateEffectiveDate 11/14/2022
CertificateExpirationDate 11/13/2024
FacilityType Waiver

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