34D2259870 CLIA NUMBER - INDYCARE MEDICAL NORTH CAROLINA

Laboratory Demographics

  • CLIA Code: 34D2259870
  • Facility Name: INDYCARE MEDICAL NORTH CAROLINA
  • Facility Address: 1706 S CANNON BLVD STE 101
    KANNAPOLIS, NC
    ZIP 28083
  • Facility Phone: 704 933-2273
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: PHILLIP T. LABAUCH
  • NPI Number: 1205662301
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 34D2259870
LAB Type Community Clinic
Facility Name INDYCARE MEDICAL NORTH CAROLINA
Street 1706 S CANNON BLVD STE 101
City KANNAPOLIS
State NC
ZIP 28083
Phone 704 933-2273
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2024
Certificate Expiration Date 5/11/2026
Facility Type Community Clinic
Lab Director PHILLIP T. LABAUCH

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