34D0897936 CLIA NUMBER - STATESVILLE CARDIOVASCULAR CLINIC PA

Laboratory Demographics

  • CLIA Code: 34D0897936
  • Facility Name: STATESVILLE CARDIOVASCULAR CLINIC PA
  • Facility Address: 738 A BRYANT ST, SUITE A
    STATESVILLE, NC
    ZIP 28677
  • Facility Phone: 704 873-1189
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NAIM BOUHUSSEIN
  • NPI Number: 1235410960
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D0897936
LAB Type Physician Office
Facility Name STATESVILLE CARDIOVASCULAR CLINIC PA
Street 738 A BRYANT ST, SUITE A
City STATESVILLE
State NC
ZIP 28677
Phone 704 873-1189
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2023
Certificate Expiration Date 10/11/2025
Facility Type Physician Office
Lab Director NAIM BOUHUSSEIN

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This page was last updated on: 6/4/2025