36D2029111 CLIA NUMBER - DAYTON - AIRPORT

Laboratory Demographics

  • CLIA Code: 36D2029111
  • Facility Name: DAYTON - AIRPORT
  • Facility Address: 10871 ENGLE ROAD
    VANDALIA, OH
    ZIP 45377
  • Facility Phone: 937 264-0400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH KELLER
  • NPI Number: 1306823638
  • Taxonomy: 261QR0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2029111
LAB Type Physician Office
Facility Name DAYTON - AIRPORT
Street 10871 ENGLE ROAD
City VANDALIA
State OH
ZIP 45377
Phone 937 264-0400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2025
Certificate Expiration Date 8/30/2027
Facility Type Physician Office
Lab Director KENNETH KELLER

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