36D1017593 CLIA NUMBER - PROVIDENCE MEDICAL GROUP PMG GERMANTOWN

Laboratory Demographics

  • CLIA Code: 36D1017593
  • Facility Name: PROVIDENCE MEDICAL GROUP PMG GERMANTOWN
  • Facility Address: 2320 BEECHWOOD DRIVE
    GERMANTOWN, OH
    ZIP 45327
  • Facility Phone: 937 297-8999
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANN SMITH
  • NPI Number: 1760658371
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 36D1017593
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL GROUP PMG GERMANTOWN
Street 2320 BEECHWOOD DRIVE
City GERMANTOWN
State OH
ZIP 45327
Phone 937 297-8999
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2024
Certificate Expiration Date 5/8/2026
Facility Type Physician Office
Lab Director ANN SMITH

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