20D2288866 CLIA NUMBER - CASCO BAY DIRECT PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 20D2288866
  • Facility Name: CASCO BAY DIRECT PRIMARY CARE
  • Facility Address: 100 BRICKHILL AVE
    SOUTH PORTLAND, ME
    ZIP 04106
  • Facility Phone: 207 407-5027
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER K. BEALL
  • NPI Number: 1679251946
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 20D2288866
LAB Type Physician Office
Facility Name CASCO BAY DIRECT PRIMARY CARE
Street 100 BRICKHILL AVE
City SOUTH PORTLAND
State ME
ZIP 04106
Phone 207 407-5027
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Physician Office
Lab Director JENNIFER K. BEALL

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