36D2267636 CLIA NUMBER - MODERN MEDICINE

Laboratory Demographics

CLIA Number: 36D2267636

Facility Name: MODERN MEDICINE

Facility Address:
5353 VALLEY VIEW DRIVE
MORROW, OH
ZIP 45152
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Facility Phone Number: 513 268-5655

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1114654753

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2267636
LAB Type	Mobile Laboratory
Facility Name	MODERN MEDICINE
Street	5353 VALLEY VIEW DRIVE
City	MORROW
State	OH
ZIP	45152
Phone	513 268-5655
CertificateType	4
CertificateEffectiveDate	8/29/2022
CertificateExpirationDate	8/28/2024
FacilityType	Waiver

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