34D2102672 CLIA NUMBER - PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Laboratory Demographics

CLIA Number: 34D2102672

Facility Name: PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Facility Address:
4251 FAYETTEVILLE ROAD
LUMBERTON, NC
ZIP 28358
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Facility Phone Number: 910 887-3217

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1376154781

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	34D2102672
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC
Street	4251 FAYETTEVILLE ROAD
City	LUMBERTON
State	NC
ZIP	28358
Phone	910 887-3217
CertificateType	4
CertificateEffectiveDate	9/28/2023
CertificateExpirationDate	9/27/2025
FacilityType	Waiver

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