41D2099630 CLIA NUMBER - THUNDERMIST HEALTH CENTER

Laboratory Demographics

  • CLIA Code: 41D2099630
  • Facility Name: THUNDERMIST HEALTH CENTER
  • Facility Address: 186 PROVIDENCE STREET
    WEST WARWICK, RI
    ZIP 02893
  • Facility Phone: 401 767-4100
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DAVID M. BOURASSA MD CMO
  • NPI Number: 1376708560
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 41D2099630
LAB Type Federally Qualified Health Center
Facility Name THUNDERMIST HEALTH CENTER
Street 186 PROVIDENCE STREET
City WEST WARWICK
State RI
ZIP 02893
Phone 401 767-4100
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Federally Qualified Health Center
Lab Director DAVID M. BOURASSA MD CMO

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