07D2076486 CLIA NUMBER - URGENT CARE MEDICAL ASSOC, LLC D/B/A - PHYSICIANONE URGENT CARE

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Laboratory Demographics

CLIA Number: 07D2076486

Facility Name: URGENT CARE MEDICAL ASSOC, LLC D/B/A - PHYSICIANONE URGENT CARE

Facility Address:
220 ROUTE 12
GROTON, CT
ZIP 06340
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Facility Phone Number: 860 446-6137

Facility Type: Other - URGENT CARE CENTER

Certificate Type: Waiver

NPI Number: 1821411828

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	07D2076486
LAB Type	Other - URGENT CARE CENTER
Facility Name	URGENT CARE MEDICAL ASSOC, LLC D/B/A - PHYSICIANONE URGENT CARE
Street	220 ROUTE 12
City	GROTON
State	CT
ZIP	06340
Phone	860 446-6137
CertificateType	4
CertificateEffectiveDate	4/21/2024
CertificateExpirationDate	4/20/2026
FacilityType	Waiver

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