22D2172681 CLIA NUMBER - ELM TREE CLINIC LLC LOWELL

Laboratory Demographics

  • CLIA Code: 22D2172681
  • Facility Name: ELM TREE CLINIC LLC LOWELL
  • Facility Address: 12 WOOD STREET
    LOWELL, MA
    ZIP 01851
  • Facility Phone: 617 302-3343
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: GORDON C. SIEK
  • NPI Number: 1538609904
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 22D2172681
LAB Type Community Clinic
Facility Name ELM TREE CLINIC LLC LOWELL
Street 12 WOOD STREET
City LOWELL
State MA
ZIP 01851
Phone 617 302-3343
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2025
Certificate Expiration Date 9/26/2027
Facility Type Community Clinic
Lab Director GORDON C. SIEK

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