21D1004037 CLIA NUMBER - SCS LLC DBA BAY SHORE PEDIATRICS

Laboratory Demographics

CLIA Number: 21D1004037

Facility Name: SCS LLC DBA BAY SHORE PEDIATRICS

Facility Address:
130 HOSPITAL RD STE 207
PRINCE FREDERICK, MD
ZIP 20678
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Facility Phone Number: 410 535-5959

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1417179771

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D1004037
LAB Type	Physician Office
Facility Name	SCS LLC DBA BAY SHORE PEDIATRICS
Street	130 HOSPITAL RD STE 207
City	PRINCE FREDERICK
State	MD
ZIP	20678
Phone	410 535-5959
CertificateType	4
CertificateEffectiveDate	9/18/2022
CertificateExpirationDate	9/17/2024
FacilityType	Waiver

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