39D2073414 CLIA NUMBER - WELLSPAN FAMILY MEDICINE - ROOSEVELT AVE

Laboratory Demographics

  • CLIA Code: 39D2073414
  • Facility Name: WELLSPAN FAMILY MEDICINE - ROOSEVELT AVE
  • Facility Address: 1401 ROOSEVELT AVENUE ATTN- PRACTICE MANAGER
    YORK, PA
    ZIP 17404
  • Facility Phone: 717 812-7000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. QUINCY O. HARBERGER
  • NPI Number: 1740835560
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D2073414
LAB Type Physician Office
Facility Name WELLSPAN FAMILY MEDICINE - ROOSEVELT AVE
Street 1401 ROOSEVELT AVENUE ATTN- PRACTICE MANAGER
City YORK
State PA
ZIP 17404
Phone 717 812-7000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2025
Certificate Expiration Date 6/7/2027
Facility Type Physician Office
Lab Director DR. QUINCY O. HARBERGER

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