39D0921485 CLIA NUMBER - NORTHERN WAYNE FAMILY HEALTH CENTER

Laboratory Demographics

CLIA Number: 39D0921485

Facility Name: NORTHERN WAYNE FAMILY HEALTH CENTER

Facility Address:
412 COMO ROAD
LAKE COMO, PA
ZIP 18437
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Facility Phone Number: 570 798-2828

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1669654596

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D0921485
LAB Type	Physician Office
Facility Name	NORTHERN WAYNE FAMILY HEALTH CENTER
Street	412 COMO ROAD
City	LAKE COMO
State	PA
ZIP	18437
Phone	570 798-2828
CertificateType	4
CertificateEffectiveDate	10/29/2022
CertificateExpirationDate	10/28/2024
FacilityType	Waiver

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