20D1106732 CLIA NUMBER - PENOBSCOT VALLEY PRIMARY CARE

Laboratory Demographics

CLIA Number: 20D1106732

Facility Name: PENOBSCOT VALLEY PRIMARY CARE

Facility Address:
PO BOX 368
LINCOLN, ME
ZIP 04457
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Facility Phone Number: 207 794-3321

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1093716086

Taxonomy: 282NC0060X - General Acute Care Hospital

CLIA Record

Field Name	Field Value
CLIA Number	20D1106732
LAB Type	Rural Health Clinic
Facility Name	PENOBSCOT VALLEY PRIMARY CARE
Street	PO BOX 368
City	LINCOLN
State	ME
ZIP	04457
Phone	207 794-3321
CertificateType	4
CertificateEffectiveDate	10/21/2023
CertificateExpirationDate	10/20/2025
FacilityType	Waiver

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