36D2043631 CLIA NUMBER - LICKING MEMORIAL ENDOCRINOLOGY

Laboratory Demographics

  • CLIA Code: 36D2043631
  • Facility Name: LICKING MEMORIAL ENDOCRINOLOGY
  • Facility Address: 1272 W MAIN ST SUITE 204
    NEWARK, OH
    ZIP 43055
  • Facility Phone: 220 564-1740
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GURUNANTHAN PALANI
  • NPI Number: 1184174682
  • Taxonomy: 261QH0100X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2043631
LAB Type Physician Office
Facility Name LICKING MEMORIAL ENDOCRINOLOGY
Street 1272 W MAIN ST SUITE 204
City NEWARK
State OH
ZIP 43055
Phone 220 564-1740
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Physician Office
Lab Director GURUNANTHAN PALANI

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