22D0930268 CLIA NUMBER - BRIGHAM PRIMARY PHYSICIANS AT FAULKNER

Laboratory Demographics

  • CLIA Code: 22D0930268
  • Facility Name: BRIGHAM PRIMARY PHYSICIANS AT FAULKNER
  • Facility Address: 1153 CENTRE ST 4TH FLOOR, STE 4070
    JAMAICA PLAIN, MA
    ZIP 02130
  • Facility Phone: 617 983-7300
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LISA OWENS
  • NPI Number: 1003913096
  • Taxonomy: 283Q00000X - Psychiatric Hospital

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CLIA Record

Field Name Field Value
CLIA Number 22D0930268
LAB Type Physician Office
Facility Name BRIGHAM PRIMARY PHYSICIANS AT FAULKNER
Street 1153 CENTRE ST 4TH FLOOR, STE 4070
City JAMAICA PLAIN
State MA
ZIP 02130
Phone 617 983-7300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2025
Certificate Expiration Date 7/1/2027
Facility Type Physician Office
Lab Director LISA OWENS

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