36D2241524 CLIA NUMBER - PRIMARY CONVENIENT CARE CORP

Laboratory Demographics

  • CLIA Code: 36D2241524
  • Facility Name: PRIMARY CONVENIENT CARE CORP
  • Facility Address: 3763 E MAIN ST
    NEW WATERFORD, OH
    ZIP 44445
  • Facility Phone: 330 420-2025
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: BROOKE L. BOYD
  • NPI Number: 1558951392
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2241524
LAB Type Practitioner Other
Facility Name PRIMARY CONVENIENT CARE CORP
Street 3763 E MAIN ST
City NEW WATERFORD
State OH
ZIP 44445
Phone 330 420-2025
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2023
Certificate Expiration Date 10/28/2025
Facility Type Practitioner Other
Lab Director BROOKE L. BOYD

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