34D2090240 CLIA NUMBER - STOUT INTERNAL MEDICINE AND WELLNESS

Laboratory Demographics

  • CLIA Code: 34D2090240
  • Facility Name: STOUT INTERNAL MEDICINE AND WELLNESS
  • Facility Address: 653 BLUEFIELD RD SUITE I
    MOORESVILLE, NC
    ZIP 28117
  • Facility Phone: 704 360-9310
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ELMER STOUT
  • NPI Number: 1093105942
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D2090240
LAB Type Physician Office
Facility Name STOUT INTERNAL MEDICINE AND WELLNESS
Street 653 BLUEFIELD RD SUITE I
City MOORESVILLE
State NC
ZIP 28117
Phone 704 360-9310
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2025
Certificate Expiration Date 1/19/2027
Facility Type Physician Office
Lab Director ELMER STOUT

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This page was last updated on: 9/29/2025