41D1027789 CLIA NUMBER - FAIRLAWN PRIMARY CARE INC

Laboratory Demographics

  • CLIA Code: 41D1027789
  • Facility Name: FAIRLAWN PRIMARY CARE INC
  • Facility Address: 966 MINERAL SPRING AVE
    NORTH PROVIDENCE, RI
    ZIP 02904
  • Facility Phone: 401 475-3063
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: FADI F. MANSOURATI MD
  • NPI Number: 1508898909
  • Taxonomy: 363LF0000X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 41D1027789
LAB Type Practitioner Other
Facility Name FAIRLAWN PRIMARY CARE INC
Street 966 MINERAL SPRING AVE
City NORTH PROVIDENCE
State RI
ZIP 02904
Phone 401 475-3063
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type Practitioner Other
Lab Director FADI F. MANSOURATI MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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