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