34D0239013 CLIA NUMBER - EAGLE FAMILY MEDICINE AT VILLAGE

Laboratory Demographics

  • CLIA Code: 34D0239013
  • Facility Name: EAGLE FAMILY MEDICINE AT VILLAGE
  • Facility Address: 301 E WENDOVER AVE SUITE 215
    GREENSBORO, NC
    ZIP 27401
  • Facility Phone: 336 379-1156
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: DR. KIMBERLEE SHAW
  • NPI Number: 1164595757
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D0239013
LAB Type Practitioner Other
Facility Name EAGLE FAMILY MEDICINE AT VILLAGE
Street 301 E WENDOVER AVE SUITE 215
City GREENSBORO
State NC
ZIP 27401
Phone 336 379-1156
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 6/23/2024
Certificate Expiration Date 6/22/2026
Facility Type Practitioner Other
Lab Director DR. KIMBERLEE SHAW

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