34D2178171 CLIA NUMBER - WILMINGTON FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 34D2178171
  • Facility Name: WILMINGTON FAMILY PRACTICE
  • Facility Address: 3971 BUSINESS 17 EAST,
    BOLIVIA, NC
    ZIP 28422
  • Facility Phone: 910 500-6451
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDWARD MCKEITHAN
  • NPI Number: 1588205397
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D2178171
LAB Type Physician Office
Facility Name WILMINGTON FAMILY PRACTICE
Street 3971 BUSINESS 17 EAST,
City BOLIVIA
State NC
ZIP 28422
Phone 910 500-6451
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2024
Certificate Expiration Date 1/27/2026
Facility Type Physician Office
Lab Director EDWARD MCKEITHAN

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