36D2323706 CLIA NUMBER - FORM AND FUNCTION HEALTHCARE, LLC

Laboratory Demographics

  • CLIA Code: 36D2323706
  • Facility Name: FORM AND FUNCTION HEALTHCARE, LLC
  • Facility Address: 4278 INDIANOLA AVENUE
    COLUMBUS, OH
    ZIP 43214
  • Facility Phone: 614 318-4144
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER A. BELL
  • NPI Number: 1932914389
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 36D2323706
LAB Type Physician Office
Facility Name FORM AND FUNCTION HEALTHCARE, LLC
Street 4278 INDIANOLA AVENUE
City COLUMBUS
State OH
ZIP 43214
Phone 614 318-4144
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Physician Office
Lab Director JENNIFER A. BELL

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