21D2096991 CLIA NUMBER - METRO XTRACARE PC

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Laboratory Demographics

CLIA Number: 21D2096991

Facility Name: METRO XTRACARE PC

Facility Address:
3608 MILFORD MILL RD
WINDSOR MILL, MD
ZIP 21244
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Facility Phone Number: 443 272-7858

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477958429

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	21D2096991
LAB Type	Physician Office
Facility Name	METRO XTRACARE PC
Street	3608 MILFORD MILL RD
City	WINDSOR MILL
State	MD
ZIP	21244
Phone	443 272-7858
CertificateType	4
CertificateEffectiveDate	6/5/2023
CertificateExpirationDate	6/4/2025
FacilityType	Waiver

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