33D0692461 CLIA NUMBER - ST JOSEPHS PHYSICIANS - PRIMARY CARE FAYETTEVILLE SUITE 104

Laboratory Demographics

  • CLIA Code: 33D0692461
  • Facility Name: ST JOSEPHS PHYSICIANS - PRIMARY CARE FAYETTEVILLE SUITE 104
  • Facility Address: 4104 MEDICAL CENTER DR - SUITE 104
    FAYETTEVILLE, NY
    ZIP 13066
  • Facility Phone: 315 663-0059
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KRISTEN MCNAMARA
  • NPI Number: 1184654212
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D0692461
LAB Type Physician Office
Facility Name ST JOSEPHS PHYSICIANS - PRIMARY CARE FAYETTEVILLE SUITE 104
Street 4104 MEDICAL CENTER DR - SUITE 104
City FAYETTEVILLE
State NY
ZIP 13066
Phone 315 663-0059
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2018
Certificate Expiration Date 3/26/2027
Facility Type Physician Office
Lab Director DR. KRISTEN MCNAMARA

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This page was last updated on: 6/4/2025