22D2121440 CLIA NUMBER - RENAISSANCE PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 22D2121440
  • Facility Name: RENAISSANCE PRIMARY CARE, LLC
  • Facility Address: 11-15 SANDERSDALE RD
    SOUTHBRIDGE, MA
    ZIP 01550
  • Facility Phone: 774 420-2311
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. SARA B. GALLANT
  • NPI Number: 1649729021
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 22D2121440
LAB Type Physician Office
Facility Name RENAISSANCE PRIMARY CARE, LLC
Street 11-15 SANDERSDALE RD
City SOUTHBRIDGE
State MA
ZIP 01550
Phone 774 420-2311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Physician Office
Lab Director DR. SARA B. GALLANT

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