34D2289501 CLIA NUMBER - RATLIFF INTEGRATIVE FAMILY MEDICINE

Laboratory Demographics

CLIA Number: 34D2289501

Facility Name: RATLIFF INTEGRATIVE FAMILY MEDICINE

Facility Address:
104-D WAXHAW PROFESSIONAL PARK
WAXHAW, NC
ZIP 28173
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Facility Phone Number: 704 560-5508

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1164129789

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2289501
LAB Type	Physician Office
Facility Name	RATLIFF INTEGRATIVE FAMILY MEDICINE
Street	104-D WAXHAW PROFESSIONAL PARK
City	WAXHAW
State	NC
ZIP	28173
Phone	704 560-5508
CertificateType	4
CertificateEffectiveDate	9/12/2023
CertificateExpirationDate	9/11/2025
FacilityType	Waiver

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