21D2157863 CLIA NUMBER - CITYWORLD FAMILY PRACTICE LLC

Laboratory Demographics

CLIA Number: 21D2157863

Facility Name: CITYWORLD FAMILY PRACTICE LLC

Facility Address:
6201 GREENBELT RD #M14
COLLEGE PARK, MD
ZIP 20740
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Facility Phone Number: 301 289-7722

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1073089959

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	21D2157863
LAB Type	Practitioner Other
Facility Name	CITYWORLD FAMILY PRACTICE LLC
Street	6201 GREENBELT RD #M14
City	COLLEGE PARK
State	MD
ZIP	20740
Phone	301 289-7722
CertificateType	4
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	Waiver

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