21D2275600 CLIA NUMBER - OC WELLNESS LLC

Laboratory Demographics

CLIA Number: 21D2275600

Facility Name: OC WELLNESS LLC

Facility Address:
100 8TH ST
POCOMOKE CITY, MD
ZIP 21851
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Facility Phone Number: 443 944-9245

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558923672

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	21D2275600
LAB Type	Physician Office
Facility Name	OC WELLNESS LLC
Street	100 8TH ST
City	POCOMOKE CITY
State	MD
ZIP	21851
Phone	443 944-9245
CertificateType	4
CertificateEffectiveDate	1/25/2023
CertificateExpirationDate	1/24/2025
FacilityType	Waiver

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