36D2309790 CLIA NUMBER - LICKING MEMORIAL HEALTH PROFESSIONALS CARDIAC ELECTROPHYSIOLOGY

Laboratory Demographics

  • CLIA Code: 36D2309790
  • Facility Name: LICKING MEMORIAL HEALTH PROFESSIONALS CARDIAC ELECTROPHYSIOLOGY
  • Facility Address: 1906 TAMARACK ROAD
    NEWARK, OH
    ZIP 43055
  • Facility Phone: (220) 564-4150
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER L. FARRELL
  • NPI Number: 1326072265
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2309790
LAB Type Physician Office
Facility Name LICKING MEMORIAL HEALTH PROFESSIONALS CARDIAC ELECTROPHYSIOLOGY
Street 1906 TAMARACK ROAD
City NEWARK
State OH
ZIP 43055
Phone 2205644150
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2024
Certificate Expiration Date 8/20/2026
Facility Type Physician Office
Lab Director JENNIFER L. FARRELL

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This page was last updated on: 5/18/2026