20D0712760 CLIA NUMBER - MRH CORP DBA NORTHERN LIGHT HEALTH MAYO HOSPITAL PHYSICIAN PRACTICES

Laboratory Demographics

  • CLIA Code: 20D0712760
  • Facility Name: MRH CORP DBA NORTHERN LIGHT HEALTH MAYO HOSPITAL PHYSICIAN PRACTICES
  • Facility Address: 895 WEST MAIN STREET
    DOVER FOXCROFT, ME
    ZIP 04426
  • Facility Phone: 207 564-4476
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVE MCDERMOTT MD
  • NPI Number: 1891888657
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 20D0712760
LAB Type Physician Office
Facility Name MRH CORP DBA NORTHERN LIGHT HEALTH MAYO HOSPITAL PHYSICIAN PRACTICES
Street 895 WEST MAIN STREET
City DOVER FOXCROFT
State ME
ZIP 04426
Phone 207 564-4476
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Physician Office
Lab Director DAVE MCDERMOTT MD

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