51D0661868 CLIA NUMBER - NORTH FORK PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 51D0661868
  • Facility Name: NORTH FORK PRIMARY CARE
  • Facility Address: 16921 MOUNTAINEER DRIVE
    RIVERTON, WV
    ZIP 26814
  • Facility Phone: 304 567-2101
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: MS. MARY ELLEN WIMER
  • NPI Number: 1417931379
  • Taxonomy: 261QF0400X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 51D0661868
LAB Type Federally Qualified Health Center
Facility Name NORTH FORK PRIMARY CARE
Street 16921 MOUNTAINEER DRIVE
City RIVERTON
State WV
ZIP 26814
Phone 304 567-2101
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 6/7/2025
Certificate Expiration Date 6/6/2027
Facility Type Federally Qualified Health Center
Lab Director MS. MARY ELLEN WIMER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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