08D2280413 CLIA NUMBER - RHEUMATOLOGY AND FIBROMYALGIA CENTER OF EXCELLENCE

Laboratory Demographics

CLIA Number: 08D2280413

Facility Name: RHEUMATOLOGY AND FIBROMYALGIA CENTER OF EXCELLENCE

Facility Address:
29 EAST MAIN STREET
MIDDLETOWN, DE
ZIP 19709
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Facility Phone Number: 302 513-0550

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1225749708

Taxonomy: 363LG0600X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	08D2280413
LAB Type	Physician Office
Facility Name	RHEUMATOLOGY AND FIBROMYALGIA CENTER OF EXCELLENCE
Street	29 EAST MAIN STREET
City	MIDDLETOWN
State	DE
ZIP	19709
Phone	302 513-0550
CertificateType	4
CertificateEffectiveDate	4/19/2023
CertificateExpirationDate	4/18/2025
FacilityType	Waiver

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