36D2121713 CLIA NUMBER - MAUMEE VALLEY INTERNIST INC

Laboratory Demographics

  • CLIA Code: 36D2121713
  • Facility Name: MAUMEE VALLEY INTERNIST INC
  • Facility Address: 960 W WOOSTER STREET, STE 205
    BOWLING GREEN, OH
    ZIP 43402
  • Facility Phone: 419 352-2105
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THURAI Y. KUMARAN
  • NPI Number: 1962775767
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2121713
LAB Type Physician Office
Facility Name MAUMEE VALLEY INTERNIST INC
Street 960 W WOOSTER STREET, STE 205
City BOWLING GREEN
State OH
ZIP 43402
Phone 419 352-2105
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2024
Certificate Expiration Date 11/13/2026
Facility Type Physician Office
Lab Director THURAI Y. KUMARAN

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