39D2125330 CLIA NUMBER - MINERS MEDICAL

Laboratory Demographics

  • CLIA Code: 39D2125330
  • Facility Name: MINERS MEDICAL
  • Facility Address: 90 EAST UNION STREET, SUITE 3
    WILKES BARRE, PA
    ZIP 18701
  • Facility Phone: 570 822-5145
  • Facility Type: Other - ALCOHOL AND DRUG TREATMEN
  • Facility Type: Waiver
  • Lab Director: DR. AMANDA M. GODFREY
  • NPI Number: 1467759399
  • Taxonomy: 261QM2800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 39D2125330
LAB Type Other - ALCOHOL AND DRUG TREATMEN
Facility Name MINERS MEDICAL
Street 90 EAST UNION STREET, SUITE 3
City WILKES BARRE
State PA
ZIP 18701
Phone 570 822-5145
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Other - ALCOHOL AND DRUG TREATMEN
Lab Director DR. AMANDA M. GODFREY

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