30D2313494 CLIA NUMBER - MID-STATE HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 30D2313494
  • Facility Name: MID-STATE HEALTH CENTER
  • Facility Address: 28 MAIN ST
    PLYMOUTH, NH
    ZIP 03264
  • Facility Phone: 603 536-8585
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DAVID FAGAN
  • NPI Number: 1114322666
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 30D2313494
LAB Type Federally Qualified Health Center
Facility Name MID-STATE HEALTH CENTER
Street 28 MAIN ST
City PLYMOUTH
State NH
ZIP 03264
Phone 603 536-8585
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Federally Qualified Health Center
Lab Director DAVID FAGAN

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