39D0908479 CLIA NUMBER - PEDIATRIC ASSOCS OF WESTMORELAND-GREENSBURG

Laboratory Demographics

CLIA Number: 39D0908479

Facility Name: PEDIATRIC ASSOCS OF WESTMORELAND-GREENSBURG

Facility Address:
555 WEST NEWTON STREET SUITE 10
GREENSBURG, PA
ZIP 15601
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Facility Phone Number: 724 832-7045

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1437528122

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	39D0908479
LAB Type	Physician Office
Facility Name	PEDIATRIC ASSOCS OF WESTMORELAND-GREENSBURG
Street	555 WEST NEWTON STREET SUITE 10
City	GREENSBURG
State	PA
ZIP	15601
Phone	724 832-7045
CertificateType	4
CertificateEffectiveDate	12/19/2023
CertificateExpirationDate	12/18/2025
FacilityType	Waiver

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