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36D2124827 CLIA NUMBER - PIONEER PHYSICIANS NETWORK/SPRINGSIDE INTERNAL MEDICINE

Laboratory Demographics

CLIA Number: 36D2124827

Facility Name: PIONEER PHYSICIANS NETWORK/SPRINGSIDE INTERNAL MEDICINE

Facility Address:
150 SPRINGSIDE DRIVE SUITE C-320
FAIRLAWN, OH
ZIP 44333
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Facility Phone Number: 330 899-9350

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1558651026

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name Field Value
CLIA Number 36D2124827
LAB Type Physician Office
Facility Name PIONEER PHYSICIANS NETWORK/SPRINGSIDE INTERNAL MEDICINE
Street 150 SPRINGSIDE DRIVE SUITE C-320
City FAIRLAWN
State OH
ZIP 44333
Phone 330 899-9350
CertificateType 4
CertificateEffectiveDate 1/26/2023
CertificateExpirationDate 1/25/2025
FacilityType Waiver

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