39D0921485 CLIA NUMBER - NORTHERN WAYNE FAMILY HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 39D0921485
  • Facility Name: NORTHERN WAYNE FAMILY HEALTH CENTER
  • Facility Address: 412 COMO ROAD
    LAKE COMO, PA
    ZIP 18437
  • Facility Phone: 570 798-2828
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RICHARD K. HACKER MD
  • NPI Number: 1669654596
  • Taxonomy: 261QF0400X - Clinic/Center

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2024
Certificate Expiration Date 10/28/2026
Facility Type Physician Office
Lab Director DR. RICHARD K. HACKER MD

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