22D2086441 CLIA NUMBER - VINEYARD MEDICAL CARE, LLC

Laboratory Demographics

  • CLIA Code: 22D2086441
  • Facility Name: VINEYARD MEDICAL CARE, LLC
  • Facility Address: 364 STATE RD
    VINEYARD HAVEN, MA
    ZIP 02568
  • Facility Phone: 508 693-4400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATHLEEN KOEHLER
  • NPI Number: 1316130701
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 22D2086441
LAB Type Physician Office
Facility Name VINEYARD MEDICAL CARE, LLC
Street 364 STATE RD
City VINEYARD HAVEN
State MA
ZIP 02568
Phone 508 693-4400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2025
Certificate Expiration Date 5/9/2027
Facility Type Physician Office
Lab Director KATHLEEN KOEHLER

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