42D2272567 CLIA NUMBER - THE INTEGRATED WELLNESS CENTER, LLC

Laboratory Demographics

CLIA Number: 42D2272567

Facility Name: THE INTEGRATED WELLNESS CENTER, LLC

Facility Address:
531 OXFORD STRRET, SUITE D5
SUMTER, SC
ZIP 29150
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Facility Phone Number: 802 792-9002

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1831708296

Taxonomy: 363LP0808X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	42D2272567
LAB Type	Practitioner Other
Facility Name	THE INTEGRATED WELLNESS CENTER, LLC
Street	531 OXFORD STRRET, SUITE D5
City	SUMTER
State	SC
ZIP	29150
Phone	802 792-9002
CertificateType	4
CertificateEffectiveDate	11/23/2022
CertificateExpirationDate	11/22/2024
FacilityType	Waiver

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