36D2193798 CLIA NUMBER - WALLACE PHYSICIAN SERVICES

Laboratory Demographics

  • CLIA Code: 36D2193798
  • Facility Name: WALLACE PHYSICIAN SERVICES
  • Facility Address: 1577A GOODMAN AVE
    CINCINNATI, OH
    ZIP 45224
  • Facility Phone: 513 521-3800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WAYMON WALLACE
  • NPI Number: 1144527870
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2193798
LAB Type Physician Office
Facility Name WALLACE PHYSICIAN SERVICES
Street 1577A GOODMAN AVE
City CINCINNATI
State OH
ZIP 45224
Phone 513 521-3800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2024
Certificate Expiration Date 9/23/2026
Facility Type Physician Office
Lab Director WAYMON WALLACE

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