36D2037387 CLIA NUMBER - PREMISE HEALTH OF OHIO MEDICAL, PA

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Laboratory Demographics

CLIA Number: 36D2037387

Facility Name: PREMISE HEALTH OF OHIO MEDICAL, PA

Facility Address:
44 SOUTH KINTNER PARKWAY SUITE A
SUNBURY, OH
ZIP 43074
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Facility Phone Number: 740 965-4362

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043582547

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	36D2037387
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF OHIO MEDICAL, PA
Street	44 SOUTH KINTNER PARKWAY SUITE A
City	SUNBURY
State	OH
ZIP	43074
Phone	740 965-4362
CertificateType	4
CertificateEffectiveDate	2/27/2024
CertificateExpirationDate	2/26/2026
FacilityType	Waiver

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