34D1099332 CLIA NUMBER - WAKE FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 34D1099332

Facility Name: WAKE FAMILY MEDICINE

Facility Address:
1831 LAKE PINE DRIVE SUITE 200
CARY, NC
ZIP 27511
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Facility Phone Number: 919 380-1849

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1215162466

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	34D1099332
LAB Type	Physician Office
Facility Name	WAKE FAMILY MEDICINE
Street	1831 LAKE PINE DRIVE SUITE 200
City	CARY
State	NC
ZIP	27511
Phone	919 380-1849
CertificateType	3
CertificateEffectiveDate	5/12/2023
CertificateExpirationDate	5/11/2025
FacilityType	PPMP

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