34D2017992 CLIA NUMBER - MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA

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Laboratory Demographics

CLIA Number: 34D2017992

Facility Name: MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA

Facility Address:
325 WESTERN BOULEVARD
JACKSONVILLE, NC
ZIP 28546
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Facility Phone Number: 910 577-1555

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295012565

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2017992
LAB Type	Physician Office
Facility Name	MED FIRST IMMEDIATE CARE & FAMILY PRACTICE, PA
Street	325 WESTERN BOULEVARD
City	JACKSONVILLE
State	NC
ZIP	28546
Phone	910 577-1555
CertificateType	4
CertificateEffectiveDate	1/12/2024
CertificateExpirationDate	1/11/2026
FacilityType	Waiver

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