21D1044480 CLIA NUMBER - MINUTE CLINIC LLC #1449

Laboratory Demographics

CLIA Number: 21D1044480

Facility Name: MINUTE CLINIC LLC #1449

Facility Address:
7955 TUCKERMAN LANE
ROCKVILLE, MD
ZIP 20854
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Facility Phone Number: 401 770-6453

Facility Type: Other - LIM SVC HLTH CARE CLINIC

Certificate Type: Waiver

NPI Number: 1134191836

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	21D1044480
LAB Type	Other - LIM SVC HLTH CARE CLINIC
Facility Name	MINUTE CLINIC LLC #1449
Street	7955 TUCKERMAN LANE
City	ROCKVILLE
State	MD
ZIP	20854
Phone	401 770-6453
CertificateType	4
CertificateEffectiveDate	8/22/2023
CertificateExpirationDate	8/21/2025
FacilityType	Waiver

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