09D2033464 CLIA NUMBER - IMMACULATE MEDICAL SERVICES

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Laboratory Demographics

CLIA Number: 09D2033464

Facility Name: IMMACULATE MEDICAL SERVICES

Facility Address:
106 IRVING STREET NW, SUITE 308 SOUTH
WASHINGTON, DC
ZIP 20010
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Facility Phone Number: 202 877-0400

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821301904

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	09D2033464
LAB Type	Physician Office
Facility Name	IMMACULATE MEDICAL SERVICES
Street	106 IRVING STREET NW, SUITE 308 SOUTH
City	WASHINGTON
State	DC
ZIP	20010
Phone	202 877-0400
CertificateType	4
CertificateEffectiveDate	12/2/2023
CertificateExpirationDate	12/1/2025
FacilityType	Waiver

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