36D1054105 CLIA NUMBER - PROVIDENCE HEALTH PARTNERS CENTER FOR CLINICAL RESEARCH

Laboratory Demographics

  • CLIA Code: 36D1054105
  • Facility Name: PROVIDENCE HEALTH PARTNERS CENTER FOR CLINICAL RESEARCH
  • Facility Address: 2912 SPRINGBORO WEST SUITE 200
    MORAINE, OH
    ZIP 45439
  • Facility Phone: 937 297-8988
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD A. HUBACH
  • NPI Number: 1821373945
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 36D1054105
LAB Type Physician Office
Facility Name PROVIDENCE HEALTH PARTNERS CENTER FOR CLINICAL RESEARCH
Street 2912 SPRINGBORO WEST SUITE 200
City MORAINE
State OH
ZIP 45439
Phone 937 297-8988
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2024
Certificate Expiration Date 5/10/2026
Facility Type Physician Office
Lab Director EDWARD A. HUBACH

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