22D0892047 CLIA NUMBER - EAST MOUNTAIN MEDICAL

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Laboratory Demographics

CLIA Number: 22D0892047

Facility Name: EAST MOUNTAIN MEDICAL

Facility Address:
780 MAIN ST
GREAT BARRINGTON, MA
ZIP 01230
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Facility Phone Number: 413 528-8643

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1881252286

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	22D0892047
LAB Type	Rural Health Clinic
Facility Name	EAST MOUNTAIN MEDICAL
Street	780 MAIN ST
City	GREAT BARRINGTON
State	MA
ZIP	01230
Phone	413 528-8643
CertificateType	4
CertificateEffectiveDate	9/22/2022
CertificateExpirationDate	9/21/2024
FacilityType	Waiver

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