34D2131699 CLIA NUMBER - CHESTNUT FAMILY PRACTICE, PLLC

Laboratory Demographics

CLIA Number: 34D2131699

Facility Name: CHESTNUT FAMILY PRACTICE, PLLC

Facility Address:
1013 CHESTNUT LANE, SUITE 110
MATTHEWS, NC
ZIP 28104
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Facility Phone Number: 704 585-8255

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1134654338

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	34D2131699
LAB Type	Physician Office
Facility Name	CHESTNUT FAMILY PRACTICE, PLLC
Street	1013 CHESTNUT LANE, SUITE 110
City	MATTHEWS
State	NC
ZIP	28104
Phone	704 585-8255
CertificateType	3
CertificateEffectiveDate	6/5/2023
CertificateExpirationDate	6/4/2025
FacilityType	PPMP

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