33D0161396 CLIA NUMBER - W BRUCE CLARK MD PC

Laboratory Demographics

  • CLIA Code: 33D0161396
  • Facility Name: W BRUCE CLARK MD PC
  • Facility Address: 585 NEW LOUDON ROAD
    LATHAM, NY
    ZIP 12110
  • Facility Phone: 518 783-1472
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. W BRUCE CLARK
  • NPI Number: 1396959110
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 33D0161396
LAB Type Physician Office
Facility Name W BRUCE CLARK MD PC
Street 585 NEW LOUDON ROAD
City LATHAM
State NY
ZIP 12110
Phone 518 783-1472
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 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type Physician Office
Lab Director DR. W BRUCE CLARK

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