41D2195153 CLIA NUMBER - WELLNESS CONNECT GO BEYOND MEDICINE, LLC

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Laboratory Demographics

CLIA Number: 41D2195153

Facility Name: WELLNESS CONNECT GO BEYOND MEDICINE, LLC

Facility Address:
655 BROAD ST. SUITE 201
PROVIDENCE, RI
ZIP 02907
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Facility Phone Number: 401 642-0100

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1487203303

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	41D2195153
LAB Type	Physician Office
Facility Name	WELLNESS CONNECT GO BEYOND MEDICINE, LLC
Street	655 BROAD ST. SUITE 201
City	PROVIDENCE
State	RI
ZIP	02907
Phone	401 642-0100
CertificateType	4
CertificateEffectiveDate	10/7/2022
CertificateExpirationDate	10/6/2024
FacilityType	Waiver

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