39D1104259 CLIA NUMBER - GREEN STREET PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 39D1104259
  • Facility Name: GREEN STREET PRIMARY CARE
  • Facility Address: 2000 GREEN STREET BLDG
    FARRELL, PA
    ZIP 16121
  • Facility Phone: 724 342-6900
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. TIMOTHY M. FULLERTON
  • NPI Number: 1275730202
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D1104259
LAB Type Federally Qualified Health Center
Facility Name GREEN STREET PRIMARY CARE
Street 2000 GREEN STREET BLDG
City FARRELL
State PA
ZIP 16121
Phone 724 342-6900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2024
Certificate Expiration Date 3/4/2026
Facility Type Federally Qualified Health Center
Lab Director DR. TIMOTHY M. FULLERTON

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This page was last updated on: 6/4/2025