34D1050261 CLIA NUMBER - BRUNSWICK CARDIOLOGY PC

Laboratory Demographics

  • CLIA Code: 34D1050261
  • Facility Name: BRUNSWICK CARDIOLOGY PC
  • Facility Address: 20 MEDICAL CAMPUS DR STE 203
    SUPPLY, NC
    ZIP 28462
  • Facility Phone: 910 755-7192
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PHYLLIS RIDGLEY LPN
  • NPI Number: 1821112673
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 34D1050261
LAB Type Physician Office
Facility Name BRUNSWICK CARDIOLOGY PC
Street 20 MEDICAL CAMPUS DR STE 203
City SUPPLY
State NC
ZIP 28462
Phone 910 755-7192
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2024
Certificate Expiration Date 1/29/2026
Facility Type Physician Office
Lab Director PHYLLIS RIDGLEY LPN

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