36D1025950 CLIA NUMBER - CANTON PRIMARY CARE AND HOSPITAL MEDICINE

Laboratory Demographics

CLIA Number: 36D1025950

Facility Name: CANTON PRIMARY CARE AND HOSPITAL MEDICINE

Facility Address:
4168 HOLIDAY ST NW
CANTON, OH
ZIP 44718
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Facility Phone Number: 330 454-1693

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932227899

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	36D1025950
LAB Type	Physician Office
Facility Name	CANTON PRIMARY CARE AND HOSPITAL MEDICINE
Street	4168 HOLIDAY ST NW
City	CANTON
State	OH
ZIP	44718
Phone	330 454-1693
CertificateType	4
CertificateEffectiveDate	5/24/2022
CertificateExpirationDate	5/23/2024
FacilityType	Waiver

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