34D0938988 CLIA NUMBER - FRYECARE LINCOLNTON MEDICAL GROUP

Laboratory Demographics

CLIA Number: 34D0938988

Facility Name: FRYECARE LINCOLNTON MEDICAL GROUP

Facility Address:
1470 E GASTON STREET, SUITE 300
LINCOLNTON, NC
ZIP 28092
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Facility Phone Number: 704 735-7474

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154005965

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D0938988
LAB Type	Physician Office
Facility Name	FRYECARE LINCOLNTON MEDICAL GROUP
Street	1470 E GASTON STREET, SUITE 300
City	LINCOLNTON
State	NC
ZIP	28092
Phone	704 735-7474
CertificateType	4
CertificateEffectiveDate	10/13/2023
CertificateExpirationDate	10/12/2025
FacilityType	Waiver

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