36D2162266 CLIA NUMBER - OHIOHEALTH PHYSICIAN GROUP EXECUTIVE HEALTH

Laboratory Demographics

CLIA Number: 36D2162266

Facility Name: OHIOHEALTH PHYSICIAN GROUP EXECUTIVE HEALTH

Facility Address:
3802 OLENTANGY RIVER ROAD
COLUMBUS, OH
ZIP 43214
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Facility Phone Number: 614 566-4599

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841649092

Taxonomy: 261QG0250X - Clinic/Center
An entity, facility, or distinct part of a facility providing analysis of family history, genetic laboratory testing and analysis, diagnosis of genetic trait, prognosis and options. Laboratory studies may be outsourced.

CLIA Record

Field Name	Field Value
CLIA Number	36D2162266
LAB Type	Physician Office
Facility Name	OHIOHEALTH PHYSICIAN GROUP EXECUTIVE HEALTH
Street	3802 OLENTANGY RIVER ROAD
City	COLUMBUS
State	OH
ZIP	43214
Phone	614 566-4599
CertificateType	4
CertificateEffectiveDate	2/20/2023
CertificateExpirationDate	2/19/2025
FacilityType	Waiver

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