20D2247614 CLIA NUMBER - CONVENIENTMD AUGUSTA

Laboratory Demographics

CLIA Number: 20D2247614

Facility Name: CONVENIENTMD AUGUSTA

Facility Address:
4 WHITTEN ROAD
AUGUSTA, ME
ZIP 04330
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Facility Phone Number: 207 466-2400

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1265103345

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D2247614
LAB Type	Other - URGENT CARE
Facility Name	CONVENIENTMD AUGUSTA
Street	4 WHITTEN ROAD
City	AUGUSTA
State	ME
ZIP	04330
Phone	207 466-2400
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