36D1034512 CLIA NUMBER - FLEAGLE INTERNAL MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 36D1034512
  • Facility Name: FLEAGLE INTERNAL MEDICINE LLC
  • Facility Address: 5250 FAR HILLS AVE SUITE 210
    DAYTON, OH
    ZIP 45429
  • Facility Phone: 937 434-4775
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KURT A. FLEAGLE
  • NPI Number: 1699967513
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D1034512
LAB Type Physician Office
Facility Name FLEAGLE INTERNAL MEDICINE LLC
Street 5250 FAR HILLS AVE SUITE 210
City DAYTON
State OH
ZIP 45429
Phone 937 434-4775
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2024
Certificate Expiration Date 12/5/2026
Facility Type Physician Office
Lab Director KURT A. FLEAGLE

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