21D2175352 CLIA NUMBER - FIVE STAR INTEGRATED HEALTH SERVICES

Laboratory Demographics

  • CLIA Code: 21D2175352
  • Facility Name: FIVE STAR INTEGRATED HEALTH SERVICES
  • Facility Address: 7310 GOVERNOR RITCHIE HWY #307
    GLEN BURNIE, MD
    ZIP 21061
  • Facility Phone: 667 204-0614
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: TAMIA ROLLINS-MUSGRAVE
  • NPI Number: 1124596606
  • Taxonomy: 363LP0808X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 21D2175352
LAB Type Physician Office
Facility Name FIVE STAR INTEGRATED HEALTH SERVICES
Street 7310 GOVERNOR RITCHIE HWY #307
City GLEN BURNIE
State MD
ZIP 21061
Phone 667 204-0614
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Physician Office
Lab Director TAMIA ROLLINS-MUSGRAVE

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This page was last updated on: 9/29/2025