30D2302879 CLIA NUMBER - TELLICA IMAGING MANCHESTER

Laboratory Demographics

  • CLIA Code: 30D2302879
  • Facility Name: TELLICA IMAGING MANCHESTER
  • Facility Address: 1100 BICENTENNIAL DR
    MANCHESTER, NH
    ZIP 03104
  • Facility Phone: 603 292-3491
  • Facility Type: Other - IMAGING CTR
  • Facility Type: Waiver
  • Lab Director: R DOUGLAS GREALLY
  • NPI Number: 1457055774
  • Taxonomy: 261QR0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 30D2302879
LAB Type Other - IMAGING CTR
Facility Name TELLICA IMAGING MANCHESTER
Street 1100 BICENTENNIAL DR
City MANCHESTER
State NH
ZIP 03104
Phone 603 292-3491
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2024
Certificate Expiration Date 4/16/2026
Facility Type Other - IMAGING CTR
Lab Director R DOUGLAS GREALLY

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