34D1031665 CLIA NUMBER - IMMANUEL FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 34D1031665
  • Facility Name: IMMANUEL FAMILY PRACTICE
  • Facility Address: 2515 OAKCREST AVE
    GREENSBORO, NC
    ZIP 27408
  • Facility Phone: 336 856-9996
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BETTI REESE
  • NPI Number: 1164487823
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 34D1031665
LAB Type Physician Office
Facility Name IMMANUEL FAMILY PRACTICE
Street 2515 OAKCREST AVE
City GREENSBORO
State NC
ZIP 27408
Phone 336 856-9996
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2024
Certificate Expiration Date 10/5/2026
Facility Type Physician Office
Lab Director BETTI REESE

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