36D2149842 CLIA NUMBER - SHRIVER FAMILY PRACTICE LTD

Laboratory Demographics

  • CLIA Code: 36D2149842
  • Facility Name: SHRIVER FAMILY PRACTICE LTD
  • Facility Address: 170 BRIDGE STREET
    JACKSON, OH
    ZIP 45640
  • Facility Phone: 740 577-3132
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: JEANETTA SHRIVER
  • NPI Number: 1043557390
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 36D2149842
LAB Type Rural Health Clinic
Facility Name SHRIVER FAMILY PRACTICE LTD
Street 170 BRIDGE STREET
City JACKSON
State OH
ZIP 45640
Phone 740 577-3132
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type Rural Health Clinic
Lab Director JEANETTA SHRIVER

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