39D0703013 CLIA NUMBER - MACISAAC FAMILY MEDICINE LLC

Laboratory Demographics

  • CLIA Code: 39D0703013
  • Facility Name: MACISAAC FAMILY MEDICINE LLC
  • Facility Address: 2000 CORPORATE DRIVE, SUITE 100
    WEXFORD, PA
    ZIP 15090
  • Facility Phone: 724 940-9190
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAVID B. MACISAAC DO
  • NPI Number: 1881615003
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0703013
LAB Type Physician Office
Facility Name MACISAAC FAMILY MEDICINE LLC
Street 2000 CORPORATE DRIVE, SUITE 100
City WEXFORD
State PA
ZIP 15090
Phone 724 940-9190
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 11/14/2024
Certificate Expiration Date 11/13/2026
Facility Type Physician Office
Lab Director DAVID B. MACISAAC DO

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