20D2249541 CLIA NUMBER - CONVENIENTMD SANFORD

Laboratory Demographics

CLIA Number: 20D2249541

Facility Name: CONVENIENTMD SANFORD

Facility Address:
1420 MAIN ST
SANFORD, ME
ZIP 04073
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Facility Phone Number: 207 850-5744

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1093460479

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	20D2249541
LAB Type	Other - URGENT CARE
Facility Name	CONVENIENTMD SANFORD
Street	1420 MAIN ST
City	SANFORD
State	ME
ZIP	04073
Phone	207 850-5744
CertificateType	4
CertificateEffectiveDate	6/15/2023
CertificateExpirationDate	6/14/2025
FacilityType	Waiver

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