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21D2267591 CLIA NUMBER - NUGAHEALTH PRIMARY CARE

Laboratory Demographics

CLIA Number: 21D2267591

Facility Name: NUGAHEALTH PRIMARY CARE

Facility Address:
3565 ELLICOTT MILLS DR SUITE B2
ELLICOTT CITY, MD
ZIP 21043
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Facility Phone Number: 240 755-1452

Facility Type: Practitioner Other

Certificate Type: Waiver
NPI Number: 1053959411

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 21D2267591
LAB Type Practitioner Other
Facility Name NUGAHEALTH PRIMARY CARE
Street 3565 ELLICOTT MILLS DR SUITE B2
City ELLICOTT CITY
State MD
ZIP 21043
Phone 240 755-1452
CertificateType 4
CertificateEffectiveDate 8/29/2022
CertificateExpirationDate 8/28/2024
FacilityType Waiver

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