34D1050261 CLIA NUMBER - BRUNSWICK CARDIOLOGY PC

Laboratory Demographics

CLIA Number: 34D1050261

Facility Name: BRUNSWICK CARDIOLOGY PC

Facility Address:
20 MEDICAL CAMPUS DR STE 203
SUPPLY, NC
ZIP 28462
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Facility Phone Number: 910 755-7192

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821112673

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

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
CertificateType	4
CertificateEffectiveDate	1/30/2024
CertificateExpirationDate	1/29/2026
FacilityType	Waiver

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