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

Laboratory Demographics

  • CLIA Code: 36D2037387
  • Facility Name: PREMISE HEALTH OF OHIO MEDICAL, PA
  • Facility Address: 44 SOUTH KINTNER PARKWAY SUITE A
    SUNBURY, OH
    ZIP 43074
  • Facility Phone: 740 965-4362
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LESLIE A. NOWELL
  • NPI Number: 1043582547
  • Taxonomy: 208D00000X - General Practice

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Physician Office
Lab Director LESLIE A. NOWELL

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