36D2247689 CLIA NUMBER - CITYBLOCK MEDICAL PRACTICE, LLC

Laboratory Demographics

CLIA Number: 36D2247689

Facility Name: CITYBLOCK MEDICAL PRACTICE, LLC

Facility Address:
6100 EAST MAIN STREET SUITE 110
COLUMBUS, OH
ZIP 43213
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Facility Phone Number: 513 591-8168

Facility Type: Other - PHYSICIANS OFFICE: MOBILE

Certificate Type: Waiver

NPI Number: 1013673821

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2247689
LAB Type	Other - PHYSICIANS OFFICE: MOBILE
Facility Name	CITYBLOCK MEDICAL PRACTICE, LLC
Street	6100 EAST MAIN STREET SUITE 110
City	COLUMBUS
State	OH
ZIP	43213
Phone	513 591-8168
CertificateType	4
CertificateEffectiveDate	1/7/2024
CertificateExpirationDate	1/6/2026
FacilityType	Waiver

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