34D2102552 CLIA NUMBER - MATTHEWS GLEN PHYSICIAN SERVICES

Laboratory Demographics

CLIA Number: 34D2102552

Facility Name: MATTHEWS GLEN PHYSICIAN SERVICES

Facility Address:
733 PAVILION VIEW DRIVE
MATTHEWS, NC
ZIP 28105
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Facility Phone Number: 267 787-4134

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841673217

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	34D2102552
LAB Type	Physician Office
Facility Name	MATTHEWS GLEN PHYSICIAN SERVICES
Street	733 PAVILION VIEW DRIVE
City	MATTHEWS
State	NC
ZIP	28105
Phone	267 787-4134
CertificateType	4
CertificateEffectiveDate	9/25/2023
CertificateExpirationDate	9/24/2025
FacilityType	Waiver

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