36D2135601 CLIA NUMBER - PREMISE HEALTH OF OHIO MEDICAL, PA

Laboratory Demographics

  • CLIA Code: 36D2135601
  • Facility Name: PREMISE HEALTH OF OHIO MEDICAL, PA
  • Facility Address: 3879 RHODES AVE
    NEW BOSTON, OH
    ZIP 45662
  • Facility Phone: 740 354-0292
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SARA MCCULLOUGH
  • NPI Number: 1639714439
  • Taxonomy: 207QA0505X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2135601
LAB Type Physician Office
Facility Name PREMISE HEALTH OF OHIO MEDICAL, PA
Street 3879 RHODES AVE
City NEW BOSTON
State OH
ZIP 45662
Phone 740 354-0292
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2025
Certificate Expiration Date 8/23/2027
Facility Type Physician Office
Lab Director SARA MCCULLOUGH

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