39D2141149 CLIA NUMBER - PRIMEMED S MAIN AVE SCRANTON

Laboratory Demographics

  • CLIA Code: 39D2141149
  • Facility Name: PRIMEMED S MAIN AVE SCRANTON
  • Facility Address: 743 S MAIN ST
    SCRANTON, PA
    ZIP 18504
  • Facility Phone: 570 969-0693
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL K. MONTELLA
  • NPI Number: 1225445612
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 39D2141149
LAB Type Physician Office
Facility Name PRIMEMED S MAIN AVE SCRANTON
Street 743 S MAIN ST
City SCRANTON
State PA
ZIP 18504
Phone 570 969-0693
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2023
Certificate Expiration Date 12/7/2025
Facility Type Physician Office
Lab Director DR. MICHAEL K. MONTELLA

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