36D2072442 CLIA NUMBER - PROVIDENCE MEDICAL GROUP INC THE HEIGHTS

Laboratory Demographics

  • CLIA Code: 36D2072442
  • Facility Name: PROVIDENCE MEDICAL GROUP INC THE HEIGHTS
  • Facility Address: 8701 OLD TROY PIKE STE 10
    HUBER HEIGHTS, OH
    ZIP 45424
  • Facility Phone: 937 297-8999
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENNIFER L. MACHUCA
  • NPI Number: 1811304595
  • Taxonomy: 213E00000X - Podiatrist

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CLIA Record

Field Name Field Value
CLIA Number 36D2072442
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL GROUP INC THE HEIGHTS
Street 8701 OLD TROY PIKE STE 10
City HUBER HEIGHTS
State OH
ZIP 45424
Phone 937 297-8999
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/30/2024
Certificate Expiration Date 1/29/2026
Facility Type Physician Office
Lab Director JENNIFER L. MACHUCA

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