39D0185947 CLIA NUMBER - WELLSPAN FAM MED NORTH 4TH ST

Laboratory Demographics

  • CLIA Code: 39D0185947
  • Facility Name: WELLSPAN FAM MED NORTH 4TH ST
  • Facility Address: 30 N 4TH STREET, 2ND FLR
    LEBANON, PA
    ZIP 17046
  • Facility Phone: 717 274-0474
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. SUKHJEET K. KAMBOJ
  • NPI Number: 1316076961
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0185947
LAB Type Physician Office
Facility Name WELLSPAN FAM MED NORTH 4TH ST
Street 30 N 4TH STREET, 2ND FLR
City LEBANON
State PA
ZIP 17046
Phone 717 274-0474
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 6/30/2024
Certificate Expiration Date 6/29/2026
Facility Type Physician Office
Lab Director DR. SUKHJEET K. KAMBOJ

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