30D1085119 CLIA NUMBER - WOLFEBORO FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 30D1085119
  • Facility Name: WOLFEBORO FAMILY MEDICINE
  • Facility Address: 240 SOUTH MAIN ST, STE A
    WOLFEBORO, NH
    ZIP 03894
  • Facility Phone: 603 569-7574
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMISON COSTELLO
  • NPI Number: 1568459931
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 30D1085119
LAB Type Physician Office
Facility Name WOLFEBORO FAMILY MEDICINE
Street 240 SOUTH MAIN ST, STE A
City WOLFEBORO
State NH
ZIP 03894
Phone 603 569-7574
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Physician Office
Lab Director JAMISON COSTELLO

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