36D1013993 CLIA NUMBER - MUDDY CREEK PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 36D1013993
  • Facility Name: MUDDY CREEK PEDIATRICS LLC
  • Facility Address: 6400 THORNBERRY CT, STE 610
    MASON, OH
    ZIP 45040
  • Facility Phone: 513 398-3900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHRYN E. OMALLEY
  • NPI Number: 1417081092
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 36D1013993
LAB Type Physician Office
Facility Name MUDDY CREEK PEDIATRICS LLC
Street 6400 THORNBERRY CT, STE 610
City MASON
State OH
ZIP 45040
Phone 513 398-3900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/4/2025
Certificate Expiration Date 5/3/2027
Facility Type Physician Office
Lab Director KATHRYN E. OMALLEY

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