20D1104364 CLIA NUMBER - NORTHERN LIGHT BLUE HILL MEMORIAL HOSPITAL PROVIDER PRACTICES

Laboratory Demographics

CLIA Number: 20D1104364

Facility Name: NORTHERN LIGHT BLUE HILL MEMORIAL HOSPITAL PROVIDER PRACTICES

Facility Address:
57 WATER ST, SUSSMAN BUILDING
BLUE HILL, ME
ZIP 04614
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Facility Phone Number: 207 374-3993

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1730779976

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D1104364
LAB Type	Physician Office
Facility Name	NORTHERN LIGHT BLUE HILL MEMORIAL HOSPITAL PROVIDER PRACTICES
Street	57 WATER ST, SUSSMAN BUILDING
City	BLUE HILL
State	ME
ZIP	04614
Phone	207 374-3993
CertificateType	4
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	Waiver

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