36D2011125 CLIA NUMBER - MCSAM AMBULATORY CARE CLINIC

Laboratory Demographics

  • CLIA Code: 36D2011125
  • Facility Name: MCSAM AMBULATORY CARE CLINIC
  • Facility Address: 495 COOPER ROAD, SUITE 330
    WESTERVILLE, OH
    ZIP 43081
  • Facility Phone: 614 234-8868
  • Facility Type: Other - ANTICOAGULATION CENTER
  • Facility Type: Waiver
  • Lab Director: RANDAL C. MILES
  • NPI Number: 1194102301
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 36D2011125
LAB Type Other - ANTICOAGULATION CENTER
Facility Name MCSAM AMBULATORY CARE CLINIC
Street 495 COOPER ROAD, SUITE 330
City WESTERVILLE
State OH
ZIP 43081
Phone 614 234-8868
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2024
Certificate Expiration Date 8/10/2026
Facility Type Other - ANTICOAGULATION CENTER
Lab Director RANDAL C. MILES

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