49D0875069 CLIA NUMBER - OLDE TOWNE MEDICAL AND DENTAL CENTER

Laboratory Demographics

  • CLIA Code: 49D0875069
  • Facility Name: OLDE TOWNE MEDICAL AND DENTAL CENTER
  • Facility Address: 5249 OLDE TOWNE ROAD - SUITE D
    WILLIAMSBURG, VA
    ZIP 23188
  • Facility Phone: 757 259-3258
  • Facility Type: Rural Health Clinic
  • Facility Type: Microscopy
  • Lab Director: KENDRA W. ROBINSON
  • NPI Number: 1316990203
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 49D0875069
LAB Type Rural Health Clinic
Facility Name OLDE TOWNE MEDICAL AND DENTAL CENTER
Street 5249 OLDE TOWNE ROAD - SUITE D
City WILLIAMSBURG
State VA
ZIP 23188
Phone 757 259-3258
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/29/2024
Certificate Expiration Date 10/28/2026
Facility Type Rural Health Clinic
Lab Director KENDRA W. ROBINSON

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This page was last updated on: 9/29/2025