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

Laboratory Demographics

  • CLIA Code: 34D2166156
  • Facility Name: SOUTHEAST PRIMARY CARE, PLLC DBA MEDI WEIGHTLOSS OF RALEIGH
  • Facility Address: 1911 FALLS VALLEY DRIVE, SUITE 105
    RALEIGH, NC
    ZIP 27615
  • Facility Phone: 919 249-4600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAMIAN A. BREZINSKI
  • NPI Number: 1619856622
  • Taxonomy: 207Q00000X - Family Medicine

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Physician Office
Lab Director DAMIAN A. BREZINSKI

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