39D2132246 CLIA NUMBER - PREMISE HEALTH OF PA MEDICAL, PC RESOURCES PC DBA THE CLINIC/PREMISE HEALTH

Laboratory Demographics

CLIA Number: 39D2132246

Facility Name: PREMISE HEALTH OF PA MEDICAL, PC RESOURCES PC DBA THE CLINIC/PREMISE HEALTH

Facility Address:
PHILADELPHIA INTL AIRPORT 8000 ESSINGTON AVE TERMINAL A EAST CONCOURSE 2ND FLOOR
PHILADELPHIA, PA
ZIP 19153
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Facility Phone Number: 215 492-2789

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1295274272

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2132246
LAB Type	Physician Office
Facility Name	PREMISE HEALTH OF PA MEDICAL, PC RESOURCES PC DBA THE CLINIC/PREMISE HEALTH
Street	PHILADELPHIA INTL AIRPORT 8000 ESSINGTON AVE TERMINAL A EAST CONCOURSE 2ND FLOOR
City	PHILADELPHIA
State	PA
ZIP	19153
Phone	215 492-2789
CertificateType	4
CertificateEffectiveDate	6/15/2023
CertificateExpirationDate	6/14/2025
FacilityType	Waiver

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