39D0200609 CLIA NUMBER - FAIRMOUNT PRIMARY CARE CENTER

Laboratory Demographics

  • CLIA Code: 39D0200609
  • Facility Name: FAIRMOUNT PRIMARY CARE CENTER
  • Facility Address: 1412-22 FAIRMOUNT AVENUE
    PHILADELPHIA, PA
    ZIP 19130
  • Facility Phone: 215 599-4851
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. GRETA J. STEWART
  • NPI Number: 1073511242
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D0200609
LAB Type Federally Qualified Health Center
Facility Name FAIRMOUNT PRIMARY CARE CENTER
Street 1412-22 FAIRMOUNT AVENUE
City PHILADELPHIA
State PA
ZIP 19130
Phone 215 599-4851
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 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Federally Qualified Health Center
Lab Director DR. GRETA J. STEWART

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