20D2046578 CLIA NUMBER - MAINEHEALTH OBGYN, PRIMARY AND FAMILY MEDICINE SOUTHERN

Laboratory Demographics

  • CLIA Code: 20D2046578
  • Facility Name: MAINEHEALTH OBGYN, PRIMARY AND FAMILY MEDICINE SOUTHERN
  • Facility Address: 887 CONGRESS ST
    PORTLAND, ME
    ZIP 04102
  • Facility Phone: 207 771-5549
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CANDICE DERSCH
  • NPI Number: 1679887277
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 20D2046578
LAB Type Physician Office
Facility Name MAINEHEALTH OBGYN, PRIMARY AND FAMILY MEDICINE SOUTHERN
Street 887 CONGRESS ST
City PORTLAND
State ME
ZIP 04102
Phone 207 771-5549
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/6/2024
Certificate Expiration Date 9/5/2026
Facility Type Physician Office
Lab Director CANDICE DERSCH

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