47D2232551 CLIA NUMBER - EVERGREEN FAMILY HEALTH

Laboratory Demographics

CLIA Number: 47D2232551

Facility Name: EVERGREEN FAMILY HEALTH

Facility Address:
426 INDUSTRIAL AVE, STE 130
WILLISTON, VT
ZIP 05495
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Facility Phone Number: 802 878-1008

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1588790562

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	47D2232551
LAB Type	Physician Office
Facility Name	EVERGREEN FAMILY HEALTH
Street	426 INDUSTRIAL AVE, STE 130
City	WILLISTON
State	VT
ZIP	05495
Phone	802 878-1008
CertificateType	3
CertificateEffectiveDate	8/16/2023
CertificateExpirationDate	8/15/2025
FacilityType	PPMP

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