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

Laboratory Demographics

  • CLIA Code: 41D2195153
  • Facility Name: WELLNESS CONNECT GO BEYOND MEDICINE, LLC
  • Facility Address: 655 BROAD ST. SUITE 201
    PROVIDENCE, RI
    ZIP 02907
  • Facility Phone: 401 642-0100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MIRIANNYS RIVAS
  • NPI Number: 1487203303
  • Taxonomy: 207Q00000X - Family Medicine

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2024
Certificate Expiration Date 10/6/2026
Facility Type Physician Office
Lab Director MIRIANNYS RIVAS

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