21D2261882 CLIA NUMBER - TIDALHEALTH COMMUNITY CLINIC

Laboratory Demographics

CLIA Number: 21D2261882

Facility Name: TIDALHEALTH COMMUNITY CLINIC

Facility Address:
145 E CARROLL STREET
SALISBURY, MD
ZIP 21801
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Facility Phone Number: 410 912-6982

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1619504735

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	21D2261882
LAB Type	Physician Office
Facility Name	TIDALHEALTH COMMUNITY CLINIC
Street	145 E CARROLL STREET
City	SALISBURY
State	MD
ZIP	21801
Phone	410 912-6982
CertificateType	4
CertificateEffectiveDate	6/7/2022
CertificateExpirationDate	6/6/2024
FacilityType	Waiver

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