22D0082205 CLIA NUMBER - SOUTHCOAST PHYSICIANS GROUP WESTPORT FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 22D0082205
  • Facility Name: SOUTHCOAST PHYSICIANS GROUP WESTPORT FAMILY MEDICINE
  • Facility Address: 827 AMERICAN LEGION HIGHWAY
    WESTPORT, MA
    ZIP 02790
  • Facility Phone: 508 636-5101
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARIVYL LAXER
  • NPI Number: 1730508557
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 22D0082205
LAB Type Physician Office
Facility Name SOUTHCOAST PHYSICIANS GROUP WESTPORT FAMILY MEDICINE
Street 827 AMERICAN LEGION HIGHWAY
City WESTPORT
State MA
ZIP 02790
Phone 508 636-5101
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/16/2024
Certificate Expiration Date 9/15/2026
Facility Type Physician Office
Lab Director MARIVYL LAXER

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