36D2165152 CLIA NUMBER - SHADYSIDE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 36D2165152
  • Facility Name: SHADYSIDE HEALTH CENTER
  • Facility Address: 4000 CENTRAL AVE
    SHADYSIDE, OH
    ZIP 43947
  • Facility Phone: 740 671-9357
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STACEY BROWN-BROCKLEHURST
  • NPI Number: 1093183204
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2165152
LAB Type Physician Office
Facility Name SHADYSIDE HEALTH CENTER
Street 4000 CENTRAL AVE
City SHADYSIDE
State OH
ZIP 43947
Phone 740 671-9357
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2025
Certificate Expiration Date 4/21/2027
Facility Type Physician Office
Lab Director STACEY BROWN-BROCKLEHURST

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