44D1103773 CLIA NUMBER - DARSALUD COMMUNITY CENTER INC

Laboratory Demographics

CLIA Number: 44D1103773

Facility Name: DARSALUD COMMUNITY CENTER INC

Facility Address:
6063 MT MORIAH EXTENDED, SUITE 4
MEMPHIS, TN
ZIP 38115
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Facility Phone Number: 901 922-5951

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174184709

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	44D1103773
LAB Type	Physician Office
Facility Name	DARSALUD COMMUNITY CENTER INC
Street	6063 MT MORIAH EXTENDED, SUITE 4
City	MEMPHIS
State	TN
ZIP	38115
Phone	901 922-5951
CertificateType	4
CertificateEffectiveDate	8/18/2023
CertificateExpirationDate	8/17/2025
FacilityType	Waiver

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