20D2204754 CLIA NUMBER - CONVENIENTMD URGENT CARE ELLSWORTH

Laboratory Demographics

  • CLIA Code: 20D2204754
  • Facility Name: CONVENIENTMD URGENT CARE ELLSWORTH
  • Facility Address: 235 HIGH STREET
    ELLSWORTH, ME
    ZIP 04605
  • Facility Phone: 207 412-5200
  • Facility Type: Other - URGENT CARE
  • Facility Type: Waiver
  • Lab Director: SHAMRANG KHALSA
  • NPI Number: 1851991251
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 20D2204754
LAB Type Other - URGENT CARE
Facility Name CONVENIENTMD URGENT CARE ELLSWORTH
Street 235 HIGH STREET
City ELLSWORTH
State ME
ZIP 04605
Phone 207 412-5200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/15/2024
Certificate Expiration Date 12/14/2026
Facility Type Other - URGENT CARE
Lab Director SHAMRANG KHALSA

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