41D1016928 CLIA NUMBER - BROADWAY MEDICAL TREATMENT CENTER LLC

Laboratory Demographics

CLIA Number: 41D1016928

Facility Name: BROADWAY MEDICAL TREATMENT CENTER LLC

Facility Address:
1053 SOUTH BROADWAY
EAST PROVIDENCE, RI
ZIP 02914
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Facility Phone Number: 401 465-8936

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104010032

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	41D1016928
LAB Type	Physician Office
Facility Name	BROADWAY MEDICAL TREATMENT CENTER LLC
Street	1053 SOUTH BROADWAY
City	EAST PROVIDENCE
State	RI
ZIP	02914
Phone	401 465-8936
CertificateType	4
CertificateEffectiveDate	9/11/2023
CertificateExpirationDate	9/10/2025
FacilityType	Waiver

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