33D2304509 CLIA NUMBER - HUDSON HEADWATERS FAMILY HEALTH AT LAKE PLACID

Laboratory Demographics

  • CLIA Code: 33D2304509
  • Facility Name: HUDSON HEADWATERS FAMILY HEALTH AT LAKE PLACID
  • Facility Address: 203 OLD MILITARY RD
    LAKE PLACID, NY
    ZIP 12946
  • Facility Phone: 518 824-2564
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: KEVIN A. GALLAGHER
  • NPI Number: 1679358873
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 33D2304509
LAB Type Federally Qualified Health Center
Facility Name HUDSON HEADWATERS FAMILY HEALTH AT LAKE PLACID
Street 203 OLD MILITARY RD
City LAKE PLACID
State NY
ZIP 12946
Phone 518 824-2564
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 3/26/2027
Facility Type Federally Qualified Health Center
Lab Director KEVIN A. GALLAGHER

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