20D2165130 CLIA NUMBER - CONVENIENTMD - BRUNSWICK

Laboratory Demographics

CLIA Number: 20D2165130

Facility Name: CONVENIENTMD - BRUNSWICK

Facility Address:
193 BATH ROAD
BRUNSWICK, ME
ZIP 04011
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Facility Phone Number: 207 424-2272

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1093276370

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D2165130
LAB Type	Other - URGENT CARE
Facility Name	CONVENIENTMD - BRUNSWICK
Street	193 BATH ROAD
City	BRUNSWICK
State	ME
ZIP	04011
Phone	207 424-2272
CertificateType	4
CertificateEffectiveDate	12/15/2022
CertificateExpirationDate	12/14/2024
FacilityType	Waiver

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