07D0709816 CLIA NUMBER - PEDIATRIC ASSOCIATES, LLC

Laboratory Demographics

CLIA Number: 07D0709816

Facility Name: PEDIATRIC ASSOCIATES, LLC

Facility Address:
43 ENTERPRISE DR
BRISTOL, CT
ZIP 06010
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Facility Phone Number: 860 589-5230

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295920015

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	07D0709816
LAB Type	Physician Office
Facility Name	PEDIATRIC ASSOCIATES, LLC
Street	43 ENTERPRISE DR
City	BRISTOL
State	CT
ZIP	06010
Phone	860 589-5230
CertificateType	4
CertificateEffectiveDate	9/11/2022
CertificateExpirationDate	9/10/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024