41D2300808 CLIA NUMBER - PAWTUCKET PRIMARY CARE, LLC

Laboratory Demographics

  • CLIA Code: 41D2300808
  • Facility Name: PAWTUCKET PRIMARY CARE, LLC
  • Facility Address: 126 PROSPECT ST STE 201
    PAWTUCKET, RI
    ZIP 02860
  • Facility Phone: 401 205-2149
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ANNE T. VALEZ
  • NPI Number: 1104315258
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 41D2300808
LAB Type Practitioner Other
Facility Name PAWTUCKET PRIMARY CARE, LLC
Street 126 PROSPECT ST STE 201
City PAWTUCKET
State RI
ZIP 02860
Phone 401 205-2149
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/15/2024
Certificate Expiration Date 3/14/2026
Facility Type Practitioner Other
Lab Director ANNE T. VALEZ

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