36D1062305 CLIA NUMBER - CUSTOM CARE MD

Laboratory Demographics

  • CLIA Code: 36D1062305
  • Facility Name: CUSTOM CARE MD
  • Facility Address: 1611 SOUTH GREEN ROAD SUITE 213
    SOUTH EUCLID, OH
    ZIP 44121
  • Facility Phone: 216 382-8000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD TOMM
  • NPI Number: 1093904476
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D1062305
LAB Type Physician Office
Facility Name CUSTOM CARE MD
Street 1611 SOUTH GREEN ROAD SUITE 213
City SOUTH EUCLID
State OH
ZIP 44121
Phone 216 382-8000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Physician Office
Lab Director RICHARD TOMM

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