39D0965236 CLIA NUMBER - ST LUKE'S FAMILY PRACTICE AT WALNUTPORT

Laboratory Demographics

  • CLIA Code: 39D0965236
  • Facility Name: ST LUKE'S FAMILY PRACTICE AT WALNUTPORT
  • Facility Address: 330 NORTH BEST AVENUE SUITE A
    WALNUTPORT, PA
    ZIP 18088
  • Facility Phone: 610 760-8080
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. COLLEEN E. MANZELLA
  • NPI Number: 1992801898
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D0965236
LAB Type Physician Office
Facility Name ST LUKE'S FAMILY PRACTICE AT WALNUTPORT
Street 330 NORTH BEST AVENUE SUITE A
City WALNUTPORT
State PA
ZIP 18088
Phone 610 760-8080
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/15/2025
Certificate Expiration Date 9/14/2027
Facility Type Physician Office
Lab Director DR. COLLEEN E. MANZELLA

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