36D2294752 CLIA NUMBER - HALCYONMD

Laboratory Demographics

CLIA Number: 36D2294752

Facility Name: HALCYONMD

Facility Address:
10123 ALLIANCE RD SUITE 130
CINCINNATI, OH
ZIP 45242
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Facility Phone Number: 513 530-1348

Facility Type: Other - MULTI-SPECIALTY CLINIC

Certificate Type: Waiver

NPI Number: 1538867031

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	36D2294752
LAB Type	Other - MULTI-SPECIALTY CLINIC
Facility Name	HALCYONMD
Street	10123 ALLIANCE RD SUITE 130
City	CINCINNATI
State	OH
ZIP	45242
Phone	513 530-1348
CertificateType	4
CertificateEffectiveDate	11/29/2023
CertificateExpirationDate	11/28/2025
FacilityType	Waiver

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