41D1004372 CLIA NUMBER - PROVIDENCE CONCENTRA URGENT CARE

Laboratory Demographics

CLIA Number: 41D1004372

Facility Name: PROVIDENCE CONCENTRA URGENT CARE

Facility Address:
290 BRANCH AVE
PROVIDENCE, RI
ZIP 02904
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Facility Phone Number: 401 722-8880

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043376684

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

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
CertificateType	4
CertificateEffectiveDate	10/15/2023
CertificateExpirationDate	10/14/2025
FacilityType	Waiver

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