33D2192453 CLIA NUMBER - FORT EDWARD-KINGSBURY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 33D2192453
  • Facility Name: FORT EDWARD-KINGSBURY HEALTH CENTER
  • Facility Address: 48 EAST ST
    FORT EDWARD, NY
    ZIP 12828
  • Facility Phone: 518 824-8630
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. THOMAS G. PORTUESE
  • NPI Number: 1427031319
  • Taxonomy: 341600000X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 33D2192453
LAB Type Federally Qualified Health Center
Facility Name FORT EDWARD-KINGSBURY HEALTH CENTER
Street 48 EAST ST
City FORT EDWARD
State NY
ZIP 12828
Phone 518 824-8630
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 9/10/2020
Certificate Expiration Date 3/26/2027
Facility Type Federally Qualified Health Center
Lab Director DR. THOMAS G. PORTUESE

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