39D0191663 CLIA NUMBER - BRODHEADSVILLE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 39D0191663
  • Facility Name: BRODHEADSVILLE FAMILY PRACTICE
  • Facility Address: 111 RT 715 SUITE 104
    BRODHEADSVILLE, PA
    ZIP 18322
  • Facility Phone: (570) 992-4208
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KRISTIN MAREK

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CLIA Record

Field Name Field Value
CLIA Number 39D0191663
LAB Type Physician Office
Facility Name BRODHEADSVILLE FAMILY PRACTICE
Street 111 RT 715 SUITE 104
City BRODHEADSVILLE
State PA
ZIP 18322
Phone 5709924208
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director DR. KRISTIN MAREK

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This page was last updated on: 5/18/2026