20D2204754 CLIA NUMBER - CONVENIENTMD ELLSWORTH

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Laboratory Demographics

CLIA Number: 20D2204754

Facility Name: CONVENIENTMD ELLSWORTH

Facility Address:
235 HIGH STREET
ELLSWORTH, ME
ZIP 04605
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Facility Phone Number: 207 412-5200

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1851991251

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D2204754
LAB Type	Other - URGENT CARE
Facility Name	CONVENIENTMD ELLSWORTH
Street	235 HIGH STREET
City	ELLSWORTH
State	ME
ZIP	04605
Phone	207 412-5200
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