21D2302343 CLIA NUMBER - TIDAL HEALTH FAMILY MEDICINE PRACTICE

Laboratory Demographics

  • CLIA Code: 21D2302343
  • Facility Name: TIDAL HEALTH FAMILY MEDICINE PRACTICE
  • Facility Address: 1315 SOUTH DIVISION STREET
    SALISBURY, MD
    ZIP 21804
  • Facility Phone: 410 543-7720
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: NICOLE M. ALU
  • NPI Number: 1114784188
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 21D2302343
LAB Type Physician Office
Facility Name TIDAL HEALTH FAMILY MEDICINE PRACTICE
Street 1315 SOUTH DIVISION STREET
City SALISBURY
State MD
ZIP 21804
Phone 410 543-7720
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 7/1/2025
Certificate Expiration Date 6/30/2027
Facility Type Physician Office
Lab Director NICOLE M. ALU

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