39D0894546 CLIA NUMBER - MEDICAL GROUP OF CORRY RHC SAINT VINCENT MEDICAL GROUP

Laboratory Demographics

CLIA Number: 39D0894546

Facility Name: MEDICAL GROUP OF CORRY RHC SAINT VINCENT MEDICAL GROUP

Facility Address:
315 YORK STREET
CORRY, PA
ZIP 16407
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Facility Phone Number: 814 664-8686

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1932129368

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D0894546
LAB Type	Physician Office
Facility Name	MEDICAL GROUP OF CORRY RHC SAINT VINCENT MEDICAL GROUP
Street	315 YORK STREET
City	CORRY
State	PA
ZIP	16407
Phone	814 664-8686
CertificateType	2
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024