36D1097047 CLIA NUMBER - KETTERING HEALTH MEDICAL GROUP UROGYNECOLOGY

Laboratory Demographics

  • CLIA Code: 36D1097047
  • Facility Name: KETTERING HEALTH MEDICAL GROUP UROGYNECOLOGY
  • Facility Address: 7740 WASHINGTON VILLAGE DRIVE SUITE 160
    CENTERVILLE, OH
    ZIP 45459
  • Facility Phone: 937 436-9825
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JESSICA KARP
  • NPI Number: 1659772887
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 36D1097047
LAB Type Physician Office
Facility Name KETTERING HEALTH MEDICAL GROUP UROGYNECOLOGY
Street 7740 WASHINGTON VILLAGE DRIVE SUITE 160
City CENTERVILLE
State OH
ZIP 45459
Phone 937 436-9825
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2025
Certificate Expiration Date 3/16/2027
Facility Type Physician Office
Lab Director JESSICA KARP

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