34D2263381 CLIA NUMBER - HOMETOWN MED OF MOYOCK AND OBX PLLC

Laboratory Demographics

CLIA Number: 34D2263381

Facility Name: HOMETOWN MED OF MOYOCK AND OBX PLLC

Facility Address:
109 CURRITUCK COMMERCIAL DRIVE SUITE A
MOYOCK, NC
ZIP 27958
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Facility Phone Number: 757 633-7143

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1750021325

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	34D2263381
LAB Type	Physician Office
Facility Name	HOMETOWN MED OF MOYOCK AND OBX PLLC
Street	109 CURRITUCK COMMERCIAL DRIVE SUITE A
City	MOYOCK
State	NC
ZIP	27958
Phone	757 633-7143
CertificateType	4
CertificateEffectiveDate	6/28/2022
CertificateExpirationDate	6/27/2024
FacilityType	Waiver

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