36D2296593 CLIA NUMBER - LITTLE LEGENDS PEDIATRICS, LLC

Laboratory Demographics

  • CLIA Code: 36D2296593
  • Facility Name: LITTLE LEGENDS PEDIATRICS, LLC
  • Facility Address: 169 W HIGH ST
    MOUNT GILEAD, OH
    ZIP 43338
  • Facility Phone: 419 751-7050
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARTIE J. GRAVITT
  • NPI Number: 1265203384
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 36D2296593
LAB Type Physician Office
Facility Name LITTLE LEGENDS PEDIATRICS, LLC
Street 169 W HIGH ST
City MOUNT GILEAD
State OH
ZIP 43338
Phone 419 751-7050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2024
Certificate Expiration Date 1/1/2026
Facility Type Physician Office
Lab Director MARTIE J. GRAVITT

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