47D0684748 CLIA NUMBER - GREEN MOUNTAIN FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 47D0684748
  • Facility Name: GREEN MOUNTAIN FAMILY PRACTICE
  • Facility Address: 87 PAINE MOUNTAIN DR
    NORTHFIELD, VT
    ZIP 05663
  • Facility Phone: 802 485-4161
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MATTHEW D. SULLIVAN
  • NPI Number: 1194701623
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 47D0684748
LAB Type Physician Office
Facility Name GREEN MOUNTAIN FAMILY PRACTICE
Street 87 PAINE MOUNTAIN DR
City NORTHFIELD
State VT
ZIP 05663
Phone 802 485-4161
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/15/2025
Certificate Expiration Date 9/14/2027
Facility Type Physician Office
Lab Director MATTHEW D. SULLIVAN

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