34D2173081 CLIA NUMBER - CITYBLOCK MEDICAL PRACTICE PA

Laboratory Demographics

  • CLIA Code: 34D2173081
  • Facility Name: CITYBLOCK MEDICAL PRACTICE PA
  • Facility Address: 3333 BROOKVIEW HILLS BLVD SUITE 102
    WINSTON-SALEM, NC
    ZIP 27103
  • Facility Phone: 336 355-2383
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL KIDDER
  • NPI Number: 1588296784
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D2173081
LAB Type Physician Office
Facility Name CITYBLOCK MEDICAL PRACTICE PA
Street 3333 BROOKVIEW HILLS BLVD SUITE 102
City WINSTON-SALEM
State NC
ZIP 27103
Phone 336 355-2383
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2023
Certificate Expiration Date 10/3/2025
Facility Type Physician Office
Lab Director DR. MICHAEL KIDDER

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