36D1007751 CLIA NUMBER - GRAND LAKE OB/GYN

Laboratory Demographics

  • CLIA Code: 36D1007751
  • Facility Name: GRAND LAKE OB/GYN
  • Facility Address: 1140 S KNOXVILLE AVE STE B
    SAINT MARYS, OH
    ZIP 45885
  • Facility Phone: 419 394-7314
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: POLLY F. TRAIN
  • NPI Number: 1699326751
  • Taxonomy: 310400000X - Assisted Living Facility

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CLIA Record

Field Name Field Value
CLIA Number 36D1007751
LAB Type Physician Office
Facility Name GRAND LAKE OB/GYN
Street 1140 S KNOXVILLE AVE STE B
City SAINT MARYS
State OH
ZIP 45885
Phone 419 394-7314
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2023
Certificate Expiration Date 12/8/2025
Facility Type Physician Office
Lab Director POLLY F. TRAIN

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