09D2273468 CLIA NUMBER - PROVIDENCE HEALTH SYSTEM

Laboratory Demographics

  • CLIA Code: 09D2273468
  • Facility Name: PROVIDENCE HEALTH SYSTEM
  • Facility Address: 1160 VARNUM ST NE
    WASHINGTON, DC
    ZIP 20017
  • Facility Phone: 202 854-7919
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. SHADI SOUFI
  • NPI Number: 1326316936
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 09D2273468
LAB Type Physician Office
Facility Name PROVIDENCE HEALTH SYSTEM
Street 1160 VARNUM ST NE
City WASHINGTON
State DC
ZIP 20017
Phone 202 854-7919
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Physician Office
Lab Director DR. SHADI SOUFI

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