34D2216913 CLIA NUMBER - WAKEMED MYCARE 365 PRIMARY CARE AND URGENT CARE - ZEBULON

Laboratory Demographics

  • CLIA Code: 34D2216913
  • Facility Name: WAKEMED MYCARE 365 PRIMARY CARE AND URGENT CARE - ZEBULON
  • Facility Address: 1260 N ARENDELL AVE
    ZEBULON, NC
    ZIP 27597
  • Facility Phone: 919 350-7180
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: THEODORE SCOTT DERSE
  • NPI Number: 1699361618
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D2216913
LAB Type Physician Office
Facility Name WAKEMED MYCARE 365 PRIMARY CARE AND URGENT CARE - ZEBULON
Street 1260 N ARENDELL AVE
City ZEBULON
State NC
ZIP 27597
Phone 919 350-7180
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2025
Certificate Expiration Date 3/16/2027
Facility Type Physician Office
Lab Director THEODORE SCOTT DERSE

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