05D2126191 CLIA NUMBER - PROVIDENT PRIMARY CARE INC

Laboratory Demographics

  • CLIA Code: 05D2126191
  • Facility Name: PROVIDENT PRIMARY CARE INC
  • Facility Address: 3349 G ST STE C
    MERCED, CA
    ZIP 95340
  • Facility Phone: 209 580-4638
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MACIEJ G. OSSOWSKI
  • NPI Number: 1154785517
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2126191
LAB Type Physician Office
Facility Name PROVIDENT PRIMARY CARE INC
Street 3349 G ST STE C
City MERCED
State CA
ZIP 95340
Phone 209 580-4638
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2025
Certificate Expiration Date 2/20/2027
Facility Type Physician Office
Lab Director MACIEJ G. OSSOWSKI

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