39D0988218 CLIA NUMBER - GEISINGER FORTY FORT

Laboratory Demographics

  • CLIA Code: 39D0988218
  • Facility Name: GEISINGER FORTY FORT
  • Facility Address: 190 WELLES STREET, SUITE 122
    FORTY FORT, PA
    ZIP 18704
  • Facility Phone: 570 718-4140
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: FERNANDO S. CARLOS
  • NPI Number: 1427291947
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 39D0988218
LAB Type Rural Health Clinic
Facility Name GEISINGER FORTY FORT
Street 190 WELLES STREET, SUITE 122
City FORTY FORT
State PA
ZIP 18704
Phone 570 718-4140
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Rural Health Clinic
Lab Director FERNANDO S. CARLOS

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