34D0996592 CLIA NUMBER - CONCORD CHILDREN'S CLINIC

Laboratory Demographics

  • CLIA Code: 34D0996592
  • Facility Name: CONCORD CHILDREN'S CLINIC
  • Facility Address: 1040 VINEHAVEN DRIVE
    CONCORD, NC
    ZIP 28025
  • Facility Phone: 704 784-1010
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HEMANT PRAKASH
  • NPI Number: 1679589212
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 34D0996592
LAB Type Physician Office
Facility Name CONCORD CHILDREN'S CLINIC
Street 1040 VINEHAVEN DRIVE
City CONCORD
State NC
ZIP 28025
Phone 704 784-1010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Physician Office
Lab Director HEMANT PRAKASH

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