41D0704984 CLIA NUMBER - SOUTHCOAST PHYSICIANS GROUP FAMILY MEDICENTER

Laboratory Demographics

  • CLIA Code: 41D0704984
  • Facility Name: SOUTHCOAST PHYSICIANS GROUP FAMILY MEDICENTER
  • Facility Address: 672 AQUIDNECK AVE
    MIDDLETOWN, RI
    ZIP 02842
  • Facility Phone: 401 847-0519
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAYANTHI PARAMESWARAN
  • NPI Number: 1215359443
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 41D0704984
LAB Type Physician Office
Facility Name SOUTHCOAST PHYSICIANS GROUP FAMILY MEDICENTER
Street 672 AQUIDNECK AVE
City MIDDLETOWN
State RI
ZIP 02842
Phone 401 847-0519
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2024
Certificate Expiration Date 5/15/2026
Facility Type Physician Office
Lab Director JAYANTHI PARAMESWARAN

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