20D0671738 CLIA NUMBER - MAINEHEALTH PEDIATRICS SOUTH PORTLAND

Laboratory Demographics

  • CLIA Code: 20D0671738
  • Facility Name: MAINEHEALTH PEDIATRICS SOUTH PORTLAND
  • Facility Address: 75 JOHN ROBERTS ROAD SUITE UNIT 8B
    SOUTH PORTLAND, ME
    ZIP 04106
  • Facility Phone: 207 775-4151
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: STEPHANIE JOY
  • NPI Number: 1598798787
  • Taxonomy: 283Q00000X - Psychiatric Hospital

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CLIA Record

Field Name Field Value
CLIA Number 20D0671738
LAB Type Physician Office
Facility Name MAINEHEALTH PEDIATRICS SOUTH PORTLAND
Street 75 JOHN ROBERTS ROAD SUITE UNIT 8B
City SOUTH PORTLAND
State ME
ZIP 04106
Phone 207 775-4151
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/17/2023
Certificate Expiration Date 11/16/2025
Facility Type Physician Office
Lab Director STEPHANIE JOY

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