34D2103131 CLIA NUMBER - SOUTHEASTERN CARDIOLOGY AND CARDIOVASCULAR CLINIC OF PEMBROKE

Laboratory Demographics

  • CLIA Code: 34D2103131
  • Facility Name: SOUTHEASTERN CARDIOLOGY AND CARDIOVASCULAR CLINIC OF PEMBROKE
  • Facility Address: 812 CANDY PARK ROAD, SUITE 5103
    PEMBROKE, NC
    ZIP 28372
  • Facility Phone: 910 671-5468
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. WILLIAM R. HERZOG
  • NPI Number: 1023292778
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 34D2103131
LAB Type Physician Office
Facility Name SOUTHEASTERN CARDIOLOGY AND CARDIOVASCULAR CLINIC OF PEMBROKE
Street 812 CANDY PARK ROAD, SUITE 5103
City PEMBROKE
State NC
ZIP 28372
Phone 910 671-5468
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/24/2025
Certificate Expiration Date 2/23/2027
Facility Type Physician Office
Lab Director DR. WILLIAM R. HERZOG

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