36D1090821 CLIA NUMBER - PREMISE HEALTH OF OHIO MEDICAL, PA

Laboratory Demographics

CLIA Number: 36D1090821

Facility Name: PREMISE HEALTH OF OHIO MEDICAL, PA

Facility Address:
40 SEMINARY STREET
GREENWICH, OH
ZIP 44837
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Facility Phone Number: 419 752-4471

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1235802034

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D1090821
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF OHIO MEDICAL, PA
Street	40 SEMINARY STREET
City	GREENWICH
State	OH
ZIP	44837
Phone	419 752-4471
CertificateType	4
CertificateEffectiveDate	10/20/2022
CertificateExpirationDate	10/19/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024