21D2099119 CLIA NUMBER - SHADY GROVE ADVENTIST HOSP EMERGENCY DEPARTMENT

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Laboratory Demographics

CLIA Number: 21D2099119

Facility Name: SHADY GROVE ADVENTIST HOSP EMERGENCY DEPARTMENT

Facility Address:
9901 MEDICAL CENTER DR
ROCKVILLE, MD
ZIP 20850
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Facility Phone Number: 240 826-7550

Facility Type: Ancillary Testing Site in Health Care Center

Certificate Type: Waiver

NPI Number: 1366489783

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	21D2099119
LAB Type	Ancillary Testing Site in Health Care Center
Facility Name	SHADY GROVE ADVENTIST HOSP EMERGENCY DEPARTMENT
Street	9901 MEDICAL CENTER DR
City	ROCKVILLE
State	MD
ZIP	20850
Phone	240 826-7550
CertificateType	4
CertificateEffectiveDate	7/21/2023
CertificateExpirationDate	7/20/2025
FacilityType	Waiver

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