08D2313170 CLIA NUMBER - TIDALHEALTH PRIMARY CARE LEWES

Laboratory Demographics

  • CLIA Code: 08D2313170
  • Facility Name: TIDALHEALTH PRIMARY CARE LEWES
  • Facility Address: 1526 SAVANNAH ROAD
    LEWES, DE
    ZIP 19958
  • Facility Phone: 302 297-2431
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JENNIFER B. KETTERMAN
  • NPI Number: 1467277863
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 08D2313170
LAB Type Physician Office
Facility Name TIDALHEALTH PRIMARY CARE LEWES
Street 1526 SAVANNAH ROAD
City LEWES
State DE
ZIP 19958
Phone 302 297-2431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2024
Certificate Expiration Date 10/24/2026
Facility Type Physician Office
Lab Director JENNIFER B. KETTERMAN

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