39D2098001 CLIA NUMBER - SOUTHAMPTON ESTATES PHYSICAN SERVICES

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Laboratory Demographics

CLIA Number: 39D2098001

Facility Name: SOUTHAMPTON ESTATES PHYSICAN SERVICES

Facility Address:
238 STREET ROAD
SOUTHAMPTON, PA
ZIP 18966
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Facility Phone Number: 215 441-6789

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225483332

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	39D2098001
LAB Type	Physician Office
Facility Name	SOUTHAMPTON ESTATES PHYSICAN SERVICES
Street	238 STREET ROAD
City	SOUTHAMPTON
State	PA
ZIP	18966
Phone	215 441-6789
CertificateType	4
CertificateEffectiveDate	6/29/2023
CertificateExpirationDate	6/28/2025
FacilityType	Waiver

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