34D2280245 CLIA NUMBER - PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C.

Laboratory Demographics

CLIA Number: 34D2280245

Facility Name: PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C.

Facility Address:
1701 PINECROFT ROAD
GREENSBORO, NC
ZIP 27407
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Facility Phone Number: 743 557-6940

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1215624580

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 34D2280245
LAB Type Physician Office
Facility Name PREMISE HEALTH OF NORTH CAROLINA MEDICAL, P.C.
Street 1701 PINECROFT ROAD
City GREENSBORO
State NC
ZIP 27407
Phone 743 557-6940
CertificateType 4
CertificateEffectiveDate 4/17/2023
CertificateExpirationDate 4/16/2025
FacilityType Waiver

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