07D2175270 CLIA NUMBER - 4 ELEMENTS DIRECT PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 07D2175270
  • Facility Name: 4 ELEMENTS DIRECT PRIMARY CARE LLC
  • Facility Address: 1199 SULLIVAN AVE, SUITE A
    SOUTH WINDSOR, CT
    ZIP 06074
  • Facility Phone: 860 469-5446
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VASANTH S. KAINKARYAM
  • NPI Number: 1730756636
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 07D2175270
LAB Type Physician Office
Facility Name 4 ELEMENTS DIRECT PRIMARY CARE LLC
Street 1199 SULLIVAN AVE, SUITE A
City SOUTH WINDSOR
State CT
ZIP 06074
Phone 860 469-5446
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Physician Office
Lab Director VASANTH S. KAINKARYAM

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This page was last updated on: 6/4/2025