20D0719653 CLIA NUMBER - PENOBSCOT NATION HEALTH DEPT

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Laboratory Demographics

CLIA Number: 20D0719653

Facility Name: PENOBSCOT NATION HEALTH DEPT

Facility Address:
23 WABANAKI WAY
INDIAN ISLAND, ME
ZIP 04468
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Facility Phone Number: 207 827-6101

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1801101993

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	20D0719653
LAB Type	Federally Qualified Health Center
Facility Name	PENOBSCOT NATION HEALTH DEPT
Street	23 WABANAKI WAY
City	INDIAN ISLAND
State	ME
ZIP	04468
Phone	207 827-6101
CertificateType	3
CertificateEffectiveDate	10/16/2022
CertificateExpirationDate	10/15/2024
FacilityType	PPMP

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