36D1079947 CLIA NUMBER - SUPERIOR MED FAMILY PRACTICE-CALDWELL

Laboratory Demographics

  • CLIA Code: 36D1079947
  • Facility Name: SUPERIOR MED FAMILY PRACTICE-CALDWELL
  • Facility Address: 18125 WOODSFIELD ROAD
    CALDWELL, OH
    ZIP 43724
  • Facility Phone: 740 439-0733
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CLARICE R. HALL
  • NPI Number: 1225080591
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 36D1079947
LAB Type Physician Office
Facility Name SUPERIOR MED FAMILY PRACTICE-CALDWELL
Street 18125 WOODSFIELD ROAD
City CALDWELL
State OH
ZIP 43724
Phone 740 439-0733
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2024
Certificate Expiration Date 2/10/2026
Facility Type Physician Office
Lab Director CLARICE R. HALL

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