41D2150385 CLIA NUMBER - MICHAEL P JOHNSON MD INC

Laboratory Demographics

CLIA Number: 41D2150385

Facility Name: MICHAEL P JOHNSON MD INC

Facility Address:
148 WEST RIVER ST STE 22B
PROVIDENCE, RI
ZIP 02904
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Facility Phone Number: 401 521-7100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1407319163

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	41D2150385
LAB Type	Physician Office
Facility Name	MICHAEL P JOHNSON MD INC
Street	148 WEST RIVER ST STE 22B
City	PROVIDENCE
State	RI
ZIP	02904
Phone	401 521-7100
CertificateType	4
CertificateEffectiveDate	6/25/2022
CertificateExpirationDate	6/24/2024
FacilityType	Waiver

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