47D0090617 CLIA NUMBER - WHITE RIVER FAMILY PRACTICE, PC

Laboratory Demographics

CLIA Number: 47D0090617

Facility Name: WHITE RIVER FAMILY PRACTICE, PC

Facility Address:
331 OLCOTT DRIVE SUITE U3
WHITE RIVER JUNCTION, VT
ZIP 05001
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Facility Phone Number: 802 295-6132

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1518032564

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	47D0090617
LAB Type	Physician Office
Facility Name	WHITE RIVER FAMILY PRACTICE, PC
Street	331 OLCOTT DRIVE SUITE U3
City	WHITE RIVER JUNCTION
State	VT
ZIP	05001
Phone	802 295-6132
CertificateType	2
CertificateEffectiveDate	5/21/2023
CertificateExpirationDate	5/20/2025
FacilityType	Compliance

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