07D0094891 CLIA NUMBER - HARTFORD HEALTHCARE MEDICAL GROUP, INC

Laboratory Demographics

  • CLIA Code: 07D0094891
  • Facility Name: HARTFORD HEALTHCARE MEDICAL GROUP, INC
  • Facility Address: 1559 SULLIVAN AVE
    SOUTH WINDSOR, CT
    ZIP 06074
  • Facility Phone: 860 545-7188
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CARA D. RIDDLE
  • NPI Number: 1295015170
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 07D0094891
LAB Type Physician Office
Facility Name HARTFORD HEALTHCARE MEDICAL GROUP, INC
Street 1559 SULLIVAN AVE
City SOUTH WINDSOR
State CT
ZIP 06074
Phone 860 545-7188
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Physician Office
Lab Director CARA D. RIDDLE

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