41D1004372 CLIA NUMBER - PROVIDENCE CONCENTRA URGENT CARE

Laboratory Demographics

  • CLIA Code: 41D1004372
  • Facility Name: PROVIDENCE CONCENTRA URGENT CARE
  • Facility Address: 290 BRANCH AVE
    PROVIDENCE, RI
    ZIP 02904
  • Facility Phone: 401 722-8880
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. TARIG FADL
  • NPI Number: 1043376684
  • Taxonomy: 111N00000X - Chiropractor

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CLIA Record

Field Name Field Value
CLIA Number 41D1004372
LAB Type Physician Office
Facility Name PROVIDENCE CONCENTRA URGENT CARE
Street 290 BRANCH AVE
City PROVIDENCE
State RI
ZIP 02904
Phone 401 722-8880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2025
Certificate Expiration Date 10/14/2027
Facility Type Physician Office
Lab Director DR. TARIG FADL

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