41D0941668 CLIA NUMBER - LIFESPAN PHYSICIAN GROUP, INC -OBSTETRICS & GYNECOLOGY

Laboratory Demographics

CLIA Number: 41D0941668

Facility Name: LIFESPAN PHYSICIAN GROUP, INC -OBSTETRICS & GYNECOLOGY

Facility Address:
148 WEST RIVER STREET STE 8
PROVIDENCE, RI
ZIP 02904
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Facility Phone Number: 401 606-3000

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1144792383

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	41D0941668
LAB Type	Physician Office
Facility Name	LIFESPAN PHYSICIAN GROUP, INC -OBSTETRICS & GYNECOLOGY
Street	148 WEST RIVER STREET STE 8
City	PROVIDENCE
State	RI
ZIP	02904
Phone	401 606-3000
CertificateType	3
CertificateEffectiveDate	3/26/2024
CertificateExpirationDate	3/25/2026
FacilityType	PPMP

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