39D0199149 CLIA NUMBER - CENTER ONE FAMILY MEDICINE

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Laboratory Demographics

CLIA Number: 39D0199149

Facility Name: CENTER ONE FAMILY MEDICINE

Facility Address:
9880 BUSTLETON AVENUE, SUITE 301
PHILADELPHIA, PA
ZIP 19115
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Facility Phone Number: (215) 827-1553

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1972074250

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D0199149
LAB Type	PHYSICIAN OFFICE
Facility Name	CENTER ONE FAMILY MEDICINE
Street	9880 BUSTLETON AVENUE, SUITE 301
City	PHILADELPHIA
State	PA
ZIP	19115
Phone	(215) 827-1553

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This page was last updated on: 5/11/2023