41D1049447 CLIA NUMBER - OCEAN STATE PRIMARY CARE LLC

Laboratory Demographics

  • CLIA Code: 41D1049447
  • Facility Name: OCEAN STATE PRIMARY CARE LLC
  • Facility Address: 300 TOLLGATE ROAD STE 203
    WARWICK, RI
    ZIP 02886
  • Facility Phone: 401 739-4350
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FARHAT IBRAHIM
  • NPI Number: 1427392075
  • Taxonomy: 103K00000X - Behavior Analyst

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CLIA Record

Field Name Field Value
CLIA Number 41D1049447
LAB Type Physician Office
Facility Name OCEAN STATE PRIMARY CARE LLC
Street 300 TOLLGATE ROAD STE 203
City WARWICK
State RI
ZIP 02886
Phone 401 739-4350
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2024
Certificate Expiration Date 1/5/2026
Facility Type Physician Office
Lab Director FARHAT IBRAHIM

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This page was last updated on: 6/4/2025