36D2201119 CLIA NUMBER - HOMETOWN FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 36D2201119
  • Facility Name: HOMETOWN FAMILY PRACTICE
  • Facility Address: 1198 WESTWOOD DRIVE, SUITE F
    VAN WERT, OH
    ZIP 45891
  • Facility Phone: 419 771-1640
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: CHRISTINE R. ULRICH
  • NPI Number: 1720687007
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2201119
LAB Type Practitioner Other
Facility Name HOMETOWN FAMILY PRACTICE
Street 1198 WESTWOOD DRIVE, SUITE F
City VAN WERT
State OH
ZIP 45891
Phone 419 771-1640
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2024
Certificate Expiration Date 11/17/2026
Facility Type Practitioner Other
Lab Director CHRISTINE R. ULRICH

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