39D2112851 CLIA NUMBER - GPHA, INC MEDICAL SUITE AT TEMPLE'S DENTAL SCHOOL

Laboratory Demographics

CLIA Number: 39D2112851

Facility Name: GPHA, INC MEDICAL SUITE AT TEMPLE'S DENTAL SCHOOL

Facility Address:
3223 NORTH BROAD STREET
PHILADELPHIA, PA
ZIP 19140
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Facility Phone Number: 215 226-3789

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1063466068

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2112851
LAB Type	Federally Qualified Health Center
Facility Name	GPHA, INC MEDICAL SUITE AT TEMPLE'S DENTAL SCHOOL
Street	3223 NORTH BROAD STREET
City	PHILADELPHIA
State	PA
ZIP	19140
Phone	215 226-3789
CertificateType	3
CertificateEffectiveDate	5/10/2024
CertificateExpirationDate	5/9/2026
FacilityType	PPMP

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