33D0881570 CLIA NUMBER - EVERGREEN HEALTH - 800 HERTEL

Laboratory Demographics

  • CLIA Code: 33D0881570
  • Facility Name: EVERGREEN HEALTH - 800 HERTEL
  • Facility Address: 800 HERTEL AVENUE
    BUFFALO, NY
    ZIP 14207
  • Facility Phone: 716 874-2441
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: DR. FATAI A. GBADAMOSI
  • NPI Number: 1356390918
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D0881570
LAB Type Community Clinic
Facility Name EVERGREEN HEALTH - 800 HERTEL
Street 800 HERTEL AVENUE
City BUFFALO
State NY
ZIP 14207
Phone 716 874-2441
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 4/1/2003
Certificate Expiration Date 3/26/2027
Facility Type Community Clinic
Lab Director DR. FATAI A. GBADAMOSI

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