34D1071440 CLIA NUMBER - PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Laboratory Demographics

CLIA Number: 34D1071440

Facility Name: PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Facility Address:
620 LOWE'S BOULEVARD
GARYSBURG, NC
ZIP 27831
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Facility Phone Number: 252 519-2436

Facility Type: Industrial

Certificate Type: Waiver

NPI Number: 1881014280

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	34D1071440
LAB Type	Industrial
Facility Name	PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC
Street	620 LOWE'S BOULEVARD
City	GARYSBURG
State	NC
ZIP	27831
Phone	252 519-2436
CertificateType	4
CertificateEffectiveDate	7/26/2023
CertificateExpirationDate	7/25/2025
FacilityType	Waiver

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