39D2103972 CLIA NUMBER - FAMILY MEDICINE QUENTIN

Laboratory Demographics

  • CLIA Code: 39D2103972
  • Facility Name: FAMILY MEDICINE QUENTIN
  • Facility Address: 1701 CORNWALL ROAD SUITE 201
    LEBANON, PA
    ZIP 17042
  • Facility Phone: 717 544-2748
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. KATELYN M. SHOE
  • NPI Number: 1902308331
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 39D2103972
LAB Type Physician Office
Facility Name FAMILY MEDICINE QUENTIN
Street 1701 CORNWALL ROAD SUITE 201
City LEBANON
State PA
ZIP 17042
Phone 717 544-2748
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/26/2023
Certificate Expiration Date 10/25/2025
Facility Type Physician Office
Lab Director DR. KATELYN M. SHOE

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