36D2319575 CLIA NUMBER - LICKING MEMORIAL FAMILY PRACTICE - UTICA

Laboratory Demographics

  • CLIA Code: 36D2319575
  • Facility Name: LICKING MEMORIAL FAMILY PRACTICE - UTICA
  • Facility Address: 240 N MAIN STREET
    UTICA, OH
    ZIP 43080
  • Facility Phone: 220 564-1960
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ELIZABETH MCINTOSH
  • NPI Number: 1497771521
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 36D2319575
LAB Type Physician Office
Facility Name LICKING MEMORIAL FAMILY PRACTICE - UTICA
Street 240 N MAIN STREET
City UTICA
State OH
ZIP 43080
Phone 220 564-1960
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Physician Office
Lab Director ELIZABETH MCINTOSH

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