34D2214791 CLIA NUMBER - REVOLUTION FAMILY MEDICINE, PLLC

Laboratory Demographics

CLIA Number: 34D2214791

Facility Name: REVOLUTION FAMILY MEDICINE, PLLC

Facility Address:
56 N BROAD ST E
ANGIER, NC
ZIP 27501
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Facility Phone Number: 919 698-6170

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1740875095

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	34D2214791
LAB Type	Physician Office
Facility Name	REVOLUTION FAMILY MEDICINE, PLLC
Street	56 N BROAD ST E
City	ANGIER
State	NC
ZIP	27501
Phone	919 698-6170
CertificateType	3
CertificateEffectiveDate	2/25/2023
CertificateExpirationDate	2/24/2025
FacilityType	PPMP

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