39D0189035 CLIA NUMBER - MONTOURSVILLE FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 39D0189035
  • Facility Name: MONTOURSVILLE FAMILY MEDICINE
  • Facility Address: 900 PLAZA DRIVE SUITE A
    MONTOURSVILLE, PA
    ZIP 17754
  • Facility Phone: 570 368-3321
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. ELIZABETH M. KLUCKA
  • NPI Number: 1619921434
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 39D0189035
LAB Type Physician Office
Facility Name MONTOURSVILLE FAMILY MEDICINE
Street 900 PLAZA DRIVE SUITE A
City MONTOURSVILLE
State PA
ZIP 17754
Phone 570 368-3321
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 5/23/2025
Certificate Expiration Date 5/22/2027
Facility Type Physician Office
Lab Director DR. ELIZABETH M. KLUCKA

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