47D2326510 CLIA NUMBER - TACONIC ESSENTIAL PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 47D2326510
  • Facility Name: TACONIC ESSENTIAL PRIMARY CARE
  • Facility Address: 79 CENTER ST, STE 1
    RUTLAND, VT
    ZIP 05701
  • Facility Phone: 802 772-7107
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TAMMY S. DEVEREUX
  • NPI Number: 1023829876
  • Taxonomy: 363LA2200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 47D2326510
LAB Type Physician Office
Facility Name TACONIC ESSENTIAL PRIMARY CARE
Street 79 CENTER ST, STE 1
City RUTLAND
State VT
ZIP 05701
Phone 802 772-7107
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/7/2025
Certificate Expiration Date 7/6/2027
Facility Type Physician Office
Lab Director TAMMY S. DEVEREUX

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