36D2168094 CLIA NUMBER - PROMEDICA PHYSICIANS INTERNAL FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 36D2168094
  • Facility Name: PROMEDICA PHYSICIANS INTERNAL FAMILY MEDICINE
  • Facility Address: 1601 BRIGHAM DR, #200
    PERRYSBURG, OH
    ZIP 43551
  • Facility Phone: 567 585-0380
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KANCHAN M. PILLAI
  • NPI Number: 1285826156
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 36D2168094
LAB Type Physician Office
Facility Name PROMEDICA PHYSICIANS INTERNAL FAMILY MEDICINE
Street 1601 BRIGHAM DR, #200
City PERRYSBURG
State OH
ZIP 43551
Phone 567 585-0380
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2025
Certificate Expiration Date 6/19/2027
Facility Type Physician Office
Lab Director KANCHAN M. PILLAI

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