20D1050279 CLIA NUMBER - MAINE MOBILE HEALTH PROGRAM

Laboratory Demographics

CLIA Number: 20D1050279

Facility Name: MAINE MOBILE HEALTH PROGRAM

Facility Address:
9 GREEN STREET
AUGUSTA, ME
ZIP 04330
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Facility Phone Number: 207 622-9252

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1376829598

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D1050279
LAB Type	Federally Qualified Health Center
Facility Name	MAINE MOBILE HEALTH PROGRAM
Street	9 GREEN STREET
City	AUGUSTA
State	ME
ZIP	04330
Phone	207 622-9252
CertificateType	4
CertificateEffectiveDate	1/30/2024
CertificateExpirationDate	1/29/2026
FacilityType	Waiver

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