34D2226613 CLIA NUMBER - PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Laboratory Demographics

CLIA Number: 34D2226613

Facility Name: PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Facility Address:
3611 POWHATAN ROAD
CLAYTON, NC
ZIP 27527
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Facility Phone Number: 919 583-4566

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1992379564

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2226613
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC
Street	3611 POWHATAN ROAD
City	CLAYTON
State	NC
ZIP	27527
Phone	919 583-4566
CertificateType	4
CertificateEffectiveDate	6/2/2023
CertificateExpirationDate	6/1/2025
FacilityType	Waiver

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