41D0084371 CLIA NUMBER - FAMILY HEALTH & SPORTS MEDICINE LLC

Laboratory Demographics

CLIA Number: 41D0084371

Facility Name: FAMILY HEALTH & SPORTS MEDICINE LLC

Facility Address:
65 SOCKANOSSET CROSS RD SUITE 301
CRANSTON, RI
ZIP 02920
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Facility Phone Number: 401 943-6910

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366441719

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	41D0084371
LAB Type	Physician Office
Facility Name	FAMILY HEALTH & SPORTS MEDICINE LLC
Street	65 SOCKANOSSET CROSS RD SUITE 301
City	CRANSTON
State	RI
ZIP	02920
Phone	401 943-6910
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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