39D0980852 CLIA NUMBER - MEMPHIS STREET PEDIATRICS

Laboratory Demographics

CLIA Number: 39D0980852

Facility Name: MEMPHIS STREET PEDIATRICS

Facility Address:
2301 E ALLEGHENY AVENUE
PHILADELPHIA, PA
ZIP 19134
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Facility Phone Number: 215 426-5566

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1588040117

Taxonomy: 363LP0200X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	39D0980852
LAB Type	Physician Office
Facility Name	MEMPHIS STREET PEDIATRICS
Street	2301 E ALLEGHENY AVENUE
City	PHILADELPHIA
State	PA
ZIP	19134
Phone	215 426-5566
CertificateType	4
CertificateEffectiveDate	6/11/2023
CertificateExpirationDate	6/10/2025
FacilityType	Waiver

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