39D0933479 CLIA NUMBER - WELLSPAN FAMILY MED IN NORTHUMBERLAND

Laboratory Demographics

  • CLIA Code: 39D0933479
  • Facility Name: WELLSPAN FAMILY MED IN NORTHUMBERLAND
  • Facility Address: 112 IRONSTONE DRIVE
    NORTHUMBERLAND, PA
    ZIP 17857
  • Facility Phone: 570 522-2990
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. SAM BANG
  • NPI Number: 1871395749
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0933479
LAB Type Physician Office
Facility Name WELLSPAN FAMILY MED IN NORTHUMBERLAND
Street 112 IRONSTONE DRIVE
City NORTHUMBERLAND
State PA
ZIP 17857
Phone 570 522-2990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2024
Certificate Expiration Date 10/18/2026
Facility Type Physician Office
Lab Director DR. SAM BANG

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