34D2064790 CLIA NUMBER - JACKSONVILLE ALLERGY, ASTHMA, & SINUS

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Laboratory Demographics

CLIA Number: 34D2064790

Facility Name: JACKSONVILLE ALLERGY, ASTHMA, & SINUS

Facility Address:
156 MEMORIAL COURT
JACKSONVILLE, NC
ZIP 28546
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Facility Phone Number: 910 353-0581

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1770771750

Taxonomy: 261QM0855X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

CLIA Record

Field Name	Field Value
CLIA Number	34D2064790
LAB Type	Physician Office
Facility Name	JACKSONVILLE ALLERGY, ASTHMA, & SINUS
Street	156 MEMORIAL COURT
City	JACKSONVILLE
State	NC
ZIP	28546
Phone	910 353-0581
CertificateType	4
CertificateEffectiveDate	8/27/2023
CertificateExpirationDate	8/26/2025
FacilityType	Waiver

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