39D2180569 CLIA NUMBER - WEDGE MEDICAL CENTER, INC

Laboratory Demographics

CLIA Number: 39D2180569

Facility Name: WEDGE MEDICAL CENTER, INC

Facility Address:
4243 FRANKFORD AVENUE
PHILADELPHIA, PA
ZIP 19124
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Facility Phone Number: 215 276-3922

Facility Type: Comp. Outpatient Rehab Facility

Certificate Type: Waiver

NPI Number: 1215176342

Taxonomy: 101YA0400X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	39D2180569
LAB Type	Comp. Outpatient Rehab Facility
Facility Name	WEDGE MEDICAL CENTER, INC
Street	4243 FRANKFORD AVENUE
City	PHILADELPHIA
State	PA
ZIP	19124
Phone	215 276-3922
CertificateType	4
CertificateEffectiveDate	3/17/2024
CertificateExpirationDate	3/16/2026
FacilityType	Waiver

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