39D2203194 CLIA NUMBER - PEDIATRIC SPECIALTY CARE PHILADELPHIA

Laboratory Demographics

  • CLIA Code: 39D2203194
  • Facility Name: PEDIATRIC SPECIALTY CARE PHILADELPHIA
  • Facility Address: 3301 SCOTTS LANE ATTN PATRICK O'CONNOR
    PHILADELPHIA, PA
    ZIP 19129
  • Facility Phone: 215 621-6155
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: DR. MEGAN E. DURHAM
  • NPI Number: 1902544711
  • Taxonomy: 1223P0221X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 39D2203194
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name PEDIATRIC SPECIALTY CARE PHILADELPHIA
Street 3301 SCOTTS LANE ATTN PATRICK O'CONNOR
City PHILADELPHIA
State PA
ZIP 19129
Phone 215 621-6155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director DR. MEGAN E. DURHAM

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