36D2124438 CLIA NUMBER - LICKING MEMORIAL FAMILY PRACTICE HEBRON

Laboratory Demographics

  • CLIA Code: 36D2124438
  • Facility Name: LICKING MEMORIAL FAMILY PRACTICE HEBRON
  • Facility Address: 96 INTEGRITY DRIVE, SUITE H
    HEBRON, OH
    ZIP 43025
  • Facility Phone: 220 564-2100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHRISTOPHER M. FORBUSH
  • NPI Number: 1689690661
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2124438
LAB Type Physician Office
Facility Name LICKING MEMORIAL FAMILY PRACTICE HEBRON
Street 96 INTEGRITY DRIVE, SUITE H
City HEBRON
State OH
ZIP 43025
Phone 220 564-2100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Physician Office
Lab Director CHRISTOPHER M. FORBUSH

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