33D2296689 CLIA NUMBER - HUDSON HEADWATERS FAMILY HEALTH AT MALONE

Laboratory Demographics

  • CLIA Code: 33D2296689
  • Facility Name: HUDSON HEADWATERS FAMILY HEALTH AT MALONE
  • Facility Address: 16 3RD ST - SUITE A
    MALONE, NY
    ZIP 12953
  • Facility Phone: 518 824-2562
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. KEVIN A. GALLAGHER
  • NPI Number: 1003691064
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2296689
LAB Type Federally Qualified Health Center
Facility Name HUDSON HEADWATERS FAMILY HEALTH AT MALONE
Street 16 3RD ST - SUITE A
City MALONE
State NY
ZIP 12953
Phone 518 824-2562
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 1/4/2024
Certificate Expiration Date 3/26/2027
Facility Type Federally Qualified Health Center
Lab Director DR. KEVIN A. GALLAGHER

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