36D2069301 CLIA NUMBER - CLEVELAND CLINIC MERCY HOSPITAL HEALTH CENTER, ST PAUL SQUARE

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Laboratory Demographics

CLIA Number: 36D2069301

Facility Name: CLEVELAND CLINIC MERCY HOSPITAL HEALTH CENTER, ST PAUL SQUARE

Facility Address:
1459 SUPERIOR AVE NE
CANTON, OH
ZIP 44705
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Facility Phone Number: 330 588-4892

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1023362100

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2069301
LAB Type	Physician Office
Facility Name	CLEVELAND CLINIC MERCY HOSPITAL HEALTH CENTER, ST PAUL SQUARE
Street	1459 SUPERIOR AVE NE
City	CANTON
State	OH
ZIP	44705
Phone	330 588-4892
CertificateType	4
CertificateEffectiveDate	11/21/2023
CertificateExpirationDate	11/20/2025
FacilityType	Waiver

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