34D1005672 CLIA NUMBER - JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA

Laboratory Demographics

  • CLIA Code: 34D1005672
  • Facility Name: JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA
  • Facility Address: 100 RIDGEVIEW DRIVE STE 105
    CARY, NC
    ZIP 27511
  • Facility Phone: 919 859-7044
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MADHUR MITTAL,
  • NPI Number: 1659411635
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 34D1005672
LAB Type Physician Office
Facility Name JACKSONVILLE CHILDREN'S AND MULTISPECIALTY CLINIC, PA
Street 100 RIDGEVIEW DRIVE STE 105
City CARY
State NC
ZIP 27511
Phone 919 859-7044
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director MADHUR MITTAL,

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