36D1033669 CLIA NUMBER - KETTERING HEALTH MEDICAL GROUP OB-GYN

Laboratory Demographics

  • CLIA Code: 36D1033669
  • Facility Name: KETTERING HEALTH MEDICAL GROUP OB-GYN
  • Facility Address: 2510 COMMONS BLVD, SUITE 270
    BEAVERCREEK, OH
    ZIP 45431
  • Facility Phone: 937 431-0200
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: WILLIAM M. MCCULLOUGH JR
  • NPI Number: 1417058314
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 36D1033669
LAB Type Physician Office
Facility Name KETTERING HEALTH MEDICAL GROUP OB-GYN
Street 2510 COMMONS BLVD, SUITE 270
City BEAVERCREEK
State OH
ZIP 45431
Phone 937 431-0200
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 11/15/2024
Certificate Expiration Date 11/14/2026
Facility Type Physician Office
Lab Director WILLIAM M. MCCULLOUGH JR

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