44D2000272 CLIA NUMBER - PRIMARY CARE GROUP LLC DBA THE INTERNAL MEDICINE CLINIC

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Laboratory Demographics

CLIA Number: 44D2000272

Facility Name: PRIMARY CARE GROUP LLC DBA THE INTERNAL MEDICINE CLINIC

Facility Address:
3950 NEW COVINGTON PIKE STE 110
MEMPHIS, TN
ZIP 38128
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Facility Phone Number: 901 387-2900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1831344183

Taxonomy: 261QH0100X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	44D2000272
LAB Type	Physician Office
Facility Name	PRIMARY CARE GROUP LLC DBA THE INTERNAL MEDICINE CLINIC
Street	3950 NEW COVINGTON PIKE STE 110
City	MEMPHIS
State	TN
ZIP	38128
Phone	901 387-2900
CertificateType	4
CertificateEffectiveDate	1/29/2023
CertificateExpirationDate	1/28/2025
FacilityType	Waiver

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