47D0931010 CLIA NUMBER - NORTHERN STATE CORRECTIONAL FACILITY

Laboratory Demographics

  • CLIA Code: 47D0931010
  • Facility Name: NORTHERN STATE CORRECTIONAL FACILITY
  • Facility Address: 2559 GLEN RD
    NEWPORT, VT
    ZIP 05855
  • Facility Phone: 802 334-3364
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: STEVEN J. FISHER
  • NPI Number: 1063186450
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 47D0931010
LAB Type Other
Facility Name NORTHERN STATE CORRECTIONAL FACILITY
Street 2559 GLEN RD
City NEWPORT
State VT
ZIP 05855
Phone 802 334-3364
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/21/2025
Certificate Expiration Date 7/20/2027
Facility Type Other
Lab Director STEVEN J. FISHER

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