34D2292667 CLIA NUMBER - PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Laboratory Demographics

CLIA Number: 34D2292667

Facility Name: PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC

Facility Address:
5938 JULIAN AIRPORT ROAD (BUILDING 801)
LIBERTY, NC
ZIP 27298
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Facility Phone Number: 743 557-6960

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1447997978

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D2292667
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF NORTH CAROLINA MEDICAL, PC
Street	5938 JULIAN AIRPORT ROAD (BUILDING 801)
City	LIBERTY
State	NC
ZIP	27298
Phone	743 557-6960
CertificateType	4
CertificateEffectiveDate	10/27/2023
CertificateExpirationDate	10/26/2025
FacilityType	Waiver

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