39D0945492 CLIA NUMBER - JEFFERSON QUEEN ANNE MEDICAL CENTER

Laboratory Demographics

CLIA Number: 39D0945492

Facility Name: JEFFERSON QUEEN ANNE MEDICAL CENTER

Facility Address:
605 S QUEEN ANNE DRIVE
FAIRLESS HILLS, PA
ZIP 19030
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Facility Phone Number: 215 949-2550

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124357462

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	39D0945492
LAB Type	Physician Office
Facility Name	JEFFERSON QUEEN ANNE MEDICAL CENTER
Street	605 S QUEEN ANNE DRIVE
City	FAIRLESS HILLS
State	PA
ZIP	19030
Phone	215 949-2550
CertificateType	4
CertificateEffectiveDate	5/4/2024
CertificateExpirationDate	5/3/2026
FacilityType	Waiver

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