36D2315317 CLIA NUMBER - KETTERING HEALTH MEDICAL GROUP PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 36D2315317
  • Facility Name: KETTERING HEALTH MEDICAL GROUP PRIMARY CARE
  • Facility Address: 817 S GETTYSBURG AVENUE
    DAYTON, OH
    ZIP 45417
  • Facility Phone: 937 294-3603
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RACHELLE DULAN
  • NPI Number: 1407405285
  • Taxonomy: 3416L0300X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 36D2315317
LAB Type Physician Office
Facility Name KETTERING HEALTH MEDICAL GROUP PRIMARY CARE
Street 817 S GETTYSBURG AVENUE
City DAYTON
State OH
ZIP 45417
Phone 937 294-3603
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Physician Office
Lab Director RACHELLE DULAN

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