39D1101222 CLIA NUMBER - LINESVILLE FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 39D1101222

Facility Name: LINESVILLE FAMILY PRACTICE

Facility Address:
210 N MERCER STREET
LINESVILLE, PA
ZIP 16424
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Facility Phone Number: 814 683-4636

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225690852

Taxonomy: 213ES0103X - Podiatrist

CLIA Record

Field Name	Field Value
CLIA Number	39D1101222
LAB Type	Physician Office
Facility Name	LINESVILLE FAMILY PRACTICE
Street	210 N MERCER STREET
City	LINESVILLE
State	PA
ZIP	16424
Phone	814 683-4636
CertificateType	4
CertificateEffectiveDate	6/23/2023
CertificateExpirationDate	6/22/2025
FacilityType	Waiver

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