08D2172466 CLIA NUMBER - TABITHA MEDICAL CARE LLC

Laboratory Demographics

CLIA Number: 08D2172466

Facility Name: TABITHA MEDICAL CARE LLC

Facility Address:
30668 SUSSEX HIGHWAY
LAUREL, DE
ZIP 19956
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Facility Phone Number: 302 251-8870

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1932669520

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	08D2172466
LAB Type	Physician Office
Facility Name	TABITHA MEDICAL CARE LLC
Street	30668 SUSSEX HIGHWAY
City	LAUREL
State	DE
ZIP	19956
Phone	302 251-8870
CertificateType	4
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	Waiver

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