36D2269545 CLIA NUMBER - MACKE FAMILY PRACTICE, LLC

Laboratory Demographics

  • CLIA Code: 36D2269545
  • Facility Name: MACKE FAMILY PRACTICE, LLC
  • Facility Address: 1025 FAIR ROAD
    SIDNEY, OH
    ZIP 45365
  • Facility Phone: 937 492-1352
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MS. DAWN D. MACKE APRN CNP
  • NPI Number: 1730816810
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2269545
LAB Type Practitioner Other
Facility Name MACKE FAMILY PRACTICE, LLC
Street 1025 FAIR ROAD
City SIDNEY
State OH
ZIP 45365
Phone 937 492-1352
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2024
Certificate Expiration Date 9/27/2026
Facility Type Practitioner Other
Lab Director MS. DAWN D. MACKE APRN CNP

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