22D0080126 CLIA NUMBER - JORDAN PHYSICIAN ASSOCIATES INC, DBA BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH GASTROENTEROLOGY

Laboratory Demographics

  • CLIA Code: 22D0080126
  • Facility Name: JORDAN PHYSICIAN ASSOCIATES INC, DBA BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH GASTROENTEROLOGY
  • Facility Address: 47 OBERY ST STE 201
    PLYMOUTH, MA
    ZIP 02360
  • Facility Phone: 508 747-1560
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN M. RUSSO
  • NPI Number: 1538145131
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 22D0080126
LAB Type Physician Office
Facility Name JORDAN PHYSICIAN ASSOCIATES INC, DBA BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH GASTROENTEROLOGY
Street 47 OBERY ST STE 201
City PLYMOUTH
State MA
ZIP 02360
Phone 508 747-1560
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director JONATHAN M. RUSSO

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