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34D2166156 CLIA NUMBER - SOUTHEAST PRIMARY CARE, PLLC DBA MEDI WEIGHTLOSS OF RALEIGH

Laboratory Demographics

CLIA Number: 34D2166156

Facility Name: SOUTHEAST PRIMARY CARE, PLLC DBA MEDI WEIGHTLOSS OF RALEIGH

Facility Address:
1911 FALLS VALLEY DRIVE, SUITE 105
RALEIGH, NC
ZIP 27615
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Facility Phone Number: 919 249-4600

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1134665789

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 34D2166156
LAB Type Physician Office
Facility Name SOUTHEAST PRIMARY CARE, PLLC DBA MEDI WEIGHTLOSS OF RALEIGH
Street 1911 FALLS VALLEY DRIVE, SUITE 105
City RALEIGH
State NC
ZIP 27615
Phone 919 249-4600
CertificateType 4
CertificateEffectiveDate 5/14/2023
CertificateExpirationDate 5/13/2025
FacilityType Waiver

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