CLIA lab
CLIA 36D0987961: Licking Memorial Family Practice
Pataskala, OH. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 36D0987961 belongs to Licking Memorial Family Practice in Pataskala, OH.
Certificate of Waiver, effective July 22, 2026, expires July 21, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- July 22, 2026
- Certificate expiration
- July 21, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- June 18, 2001
- Facility type
- Physician office
- Ownership (control type)
- Private
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 36D0987961
- Lab name
- Licking Memorial Family Practice
- Address
- One Healthy Place Suite 201, Pataskala, OH 43062
- Phone
- (740) 348-1906
- Fax
- (740) 348-1931
Annual test volume the lab reported
- Waived tests
- 200
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Kroger Pharmacy #16591Certificate of Waiver, Pharmacy36D1089935
- Licking Memorial Health Center atCertificate of Waiver, Physician office36D2287028
- Licking Memorial Health SystemsCertificate for Provider-Performed Microscopy Procedures, Physician office36D2080678
- Licking Memorial Hospital Urgent CareCertificate of Waiver, Ancillary test site36D1095069
- Licking Memorial Pediatrics PataskalaCertificate of Waiver, Physician office36D0957202
- Licking Memorial Women's HealthCertificate of Waiver, Physician office36D1036913
- Little Clinic of Ohio LLC, theCertificate of Waiver, Other36D2059800
- Medcor Clinic at Jeld-Wen-PataskalaCertificate of Waiver, Industrial36D2343865
Related
Questions
What is the CLIA number for Licking Memorial Family Practice in Pataskala?
36D0987961, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Licking Memorial Family Practice hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 36D0987961 expire?
The CMS file lists July 21, 2028 as the certificate expiration date; the certificate took effect July 22, 2026.