36D1045226 CLIA NUMBER - MONCLOVA ROAD PEDIATRICS

Laboratory Demographics

  • CLIA Code: 36D1045226
  • Facility Name: MONCLOVA ROAD PEDIATRICS
  • Facility Address: 5757 MONCLOVA ROAD #10
    MAUMEE, OH
    ZIP 43537
  • Facility Phone: 419 887-0803
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHRYN R. DAVIS
  • NPI Number: 1679901649
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 36D1045226
LAB Type Physician Office
Facility Name MONCLOVA ROAD PEDIATRICS
Street 5757 MONCLOVA ROAD #10
City MAUMEE
State OH
ZIP 43537
Phone 419 887-0803
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2025
Certificate Expiration Date 9/7/2027
Facility Type Physician Office
Lab Director KATHRYN R. DAVIS

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