47D1100531 CLIA NUMBER - CHAMPLAIN VALLEY ORAL AND MAXILLOFACIAL SURGERY

Laboratory Demographics

  • CLIA Code: 47D1100531
  • Facility Name: CHAMPLAIN VALLEY ORAL AND MAXILLOFACIAL SURGERY
  • Facility Address: 441 WATER TOWER CIRCLE, STE 100
    COLCHESTER, VT
    ZIP 05446
  • Facility Phone: 802 862-9196
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JAMES E. FREEMAN
  • NPI Number: 1902990674
  • Taxonomy: 261QU0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 47D1100531
LAB Type Physician Office
Facility Name CHAMPLAIN VALLEY ORAL AND MAXILLOFACIAL SURGERY
Street 441 WATER TOWER CIRCLE, STE 100
City COLCHESTER
State VT
ZIP 05446
Phone 802 862-9196
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2025
Certificate Expiration Date 6/7/2027
Facility Type Physician Office
Lab Director JAMES E. FREEMAN

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