36D2120452 CLIA NUMBER - KETTERING HEALTH MEDICAL GROUP CARDIOVASCULAR

Laboratory Demographics

  • CLIA Code: 36D2120452
  • Facility Name: KETTERING HEALTH MEDICAL GROUP CARDIOVASCULAR
  • Facility Address: 600 WEST MAIN ST SUITE 330
    TROY, OH
    ZIP 45373
  • Facility Phone: 937 980-7400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RYAN S. CLARK
  • NPI Number: 1023587045
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 36D2120452
LAB Type Physician Office
Facility Name KETTERING HEALTH MEDICAL GROUP CARDIOVASCULAR
Street 600 WEST MAIN ST SUITE 330
City TROY
State OH
ZIP 45373
Phone 937 980-7400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2024
Certificate Expiration Date 10/17/2026
Facility Type Physician Office
Lab Director RYAN S. CLARK

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