34D0991958 CLIA NUMBER - CAROLINA MERCY MEDICAL CLINIC

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Laboratory Demographics

CLIA Number: 34D0991958

Facility Name: CAROLINA MERCY MEDICAL CLINIC

Facility Address:
2101 W FRANKLIN BLVD
GASTONIA, NC
ZIP 28052
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Facility Phone Number: 704 867-8855

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104154988

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D0991958
LAB Type	Physician Office
Facility Name	CAROLINA MERCY MEDICAL CLINIC
Street	2101 W FRANKLIN BLVD
City	GASTONIA
State	NC
ZIP	28052
Phone	704 867-8855
CertificateType	4
CertificateEffectiveDate	5/17/2023
CertificateExpirationDate	5/16/2025
FacilityType	Waiver

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