36D1018089 CLIA NUMBER - PROMEDICA PHYSICIANS GENITO-URINARY SURGEONS

Laboratory Demographics

  • CLIA Code: 36D1018089
  • Facility Name: PROMEDICA PHYSICIANS GENITO-URINARY SURGEONS
  • Facility Address: 121 WESTFIELD DR WESTFIELD MEDICAL CENTER
    ARCHBOLD, OH
    ZIP 43502
  • Facility Phone: 567 444-4748
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GREGOR K. EMMERT
  • NPI Number: 1477990893
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 36D1018089
LAB Type Physician Office
Facility Name PROMEDICA PHYSICIANS GENITO-URINARY SURGEONS
Street 121 WESTFIELD DR WESTFIELD MEDICAL CENTER
City ARCHBOLD
State OH
ZIP 43502
Phone 567 444-4748
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/14/2023
Certificate Expiration Date 10/13/2025
Facility Type Physician Office
Lab Director GREGOR K. EMMERT

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