36D1100270 CLIA NUMBER - GLENN R BLACK MD

Laboratory Demographics

  • CLIA Code: 36D1100270
  • Facility Name: GLENN R BLACK MD
  • Facility Address: 103 5TH STREET SE SUITE S
    BARBERTON, OH
    ZIP 44203
  • Facility Phone: 330 753-5863
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GLENN R. BLACK
  • NPI Number: 1700860970
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D1100270
LAB Type Physician Office
Facility Name GLENN R BLACK MD
Street 103 5TH STREET SE SUITE S
City BARBERTON
State OH
ZIP 44203
Phone 330 753-5863
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2024
Certificate Expiration Date 3/20/2026
Facility Type Physician Office
Lab Director GLENN R. BLACK

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