36D2246262 CLIA NUMBER - PREMIER HEALTH URGENT CARE OHIO MASONIC

Laboratory Demographics

  • CLIA Code: 36D2246262
  • Facility Name: PREMIER HEALTH URGENT CARE OHIO MASONIC
  • Facility Address: 2655 W NATIONAL RD
    SPRINGFIELD, OH
    ZIP 45504
  • Facility Phone: 937 525-5578
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMANDA D. PULFER
  • NPI Number: 1861532434
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2246262
LAB Type Physician Office
Facility Name PREMIER HEALTH URGENT CARE OHIO MASONIC
Street 2655 W NATIONAL RD
City SPRINGFIELD
State OH
ZIP 45504
Phone 937 525-5578
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Physician Office
Lab Director AMANDA D. PULFER

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