34D2117053 CLIA NUMBER - STAR MEDICAL CLINIC, PLLC

Laboratory Demographics

CLIA Number: 34D2117053

Facility Name: STAR MEDICAL CLINIC, PLLC

Facility Address:
461 WESTERN BOULEVARD, SUITE 122
JACKSONVILLE, NC
ZIP 28546
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Facility Phone Number: 910 330-2335

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1033565007

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	34D2117053
LAB Type	Physician Office
Facility Name	STAR MEDICAL CLINIC, PLLC
Street	461 WESTERN BOULEVARD, SUITE 122
City	JACKSONVILLE
State	NC
ZIP	28546
Phone	910 330-2335
CertificateType	4
CertificateEffectiveDate	8/8/2022
CertificateExpirationDate	8/7/2024
FacilityType	Waiver

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