22D2148423 CLIA NUMBER - PREMISE HEALTH OF MASSACHUSETTS MEDICAL, PC

Laboratory Demographics

  • CLIA Code: 22D2148423
  • Facility Name: PREMISE HEALTH OF MASSACHUSETTS MEDICAL, PC
  • Facility Address: 1 SOUTH SPENCER ROAD
    SPENCER, MA
    ZIP 01562
  • Facility Phone: 800 213-7522
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THOMAS HICKS
  • NPI Number: 1558760199
  • Taxonomy: 251E00000X - Home Health

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CLIA Record

Field Name Field Value
CLIA Number 22D2148423
LAB Type Physician Office
Facility Name PREMISE HEALTH OF MASSACHUSETTS MEDICAL, PC
Street 1 SOUTH SPENCER ROAD
City SPENCER
State MA
ZIP 01562
Phone 800 213-7522
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/10/2024
Certificate Expiration Date 5/9/2026
Facility Type Physician Office
Lab Director THOMAS HICKS

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