36D2211963 CLIA NUMBER - ETERNAL IMPRESSIONS, LLC DBA JIVA MED SPA

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Laboratory Demographics

CLIA Number: 36D2211963

Facility Name: ETERNAL IMPRESSIONS, LLC DBA JIVA MED SPA

Facility Address:
1127 DUBLIN ROAD
COLUMBUS, OH
ZIP 43215
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Facility Phone Number: 614 421-7546

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1831578350

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	36D2211963
LAB Type	Physician Office
Facility Name	ETERNAL IMPRESSIONS, LLC DBA JIVA MED SPA
Street	1127 DUBLIN ROAD
City	COLUMBUS
State	OH
ZIP	43215
Phone	614 421-7546
CertificateType	4
CertificateEffectiveDate	2/2/2023
CertificateExpirationDate	2/1/2025
FacilityType	Waiver

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