34D0666106 CLIA NUMBER - EAGLE FAMILY MEDICINE AT BRASSFIELD

Laboratory Demographics

  • CLIA Code: 34D0666106
  • Facility Name: EAGLE FAMILY MEDICINE AT BRASSFIELD
  • Facility Address: 3800 ROBERT PORCHER WAY SUITE 200
    GREENSBORO, NC
    ZIP 27410
  • Facility Phone: 336 282-0376
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DIBAS KOIRALA
  • NPI Number: 1710073606
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D0666106
LAB Type Physician Office
Facility Name EAGLE FAMILY MEDICINE AT BRASSFIELD
Street 3800 ROBERT PORCHER WAY SUITE 200
City GREENSBORO
State NC
ZIP 27410
Phone 336 282-0376
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 3/25/2024
Certificate Expiration Date 3/24/2026
Facility Type Physician Office
Lab Director DIBAS KOIRALA

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