36D2127692 CLIA NUMBER - KETTERING HEALTH MEDICAL GROUP SOIN FAMILY MEDICINE CENTER

Laboratory Demographics

  • CLIA Code: 36D2127692
  • Facility Name: KETTERING HEALTH MEDICAL GROUP SOIN FAMILY MEDICINE CENTER
  • Facility Address: 2145 N FAIRFIELD RD, STE 100
    BEAVERCREEK, OH
    ZIP 45431
  • Facility Phone: 937 558-3900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHON M. GASKILL
  • NPI Number: 1639582182
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2127692
LAB Type Physician Office
Facility Name KETTERING HEALTH MEDICAL GROUP SOIN FAMILY MEDICINE CENTER
Street 2145 N FAIRFIELD RD, STE 100
City BEAVERCREEK
State OH
ZIP 45431
Phone 937 558-3900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Physician Office
Lab Director JONATHON M. GASKILL

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