34D1034853 CLIA NUMBER - PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Laboratory Demographics

CLIA Number: 34D1034853

Facility Name: PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Facility Address:
4701 PURDUE DRIVE
WILSON, NC
ZIP 27893
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Facility Phone Number: 252 265-1957

Facility Type: Other

Certificate Type: Waiver

NPI Number: 1255733556

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D1034853
LAB Type	Other
Facility Name	PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC
Street	4701 PURDUE DRIVE
City	WILSON
State	NC
ZIP	27893
Phone	252 265-1957
CertificateType	4
CertificateEffectiveDate	12/15/2022
CertificateExpirationDate	12/14/2024
FacilityType	Waiver

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