49D0911343 CLIA NUMBER - TIDEWATER PHYSICIANS MULTISPECIALITY GROUP, PC

Laboratory Demographics

  • CLIA Code: 49D0911343
  • Facility Name: TIDEWATER PHYSICIANS MULTISPECIALITY GROUP, PC
  • Facility Address: 860 OMNI BOULEVARD - SUITE 105
    NEWPORT NEWS, VA
    ZIP 23606
  • Facility Phone: (757) 873-0952
  • Facility Type: Other
  • Facility Type: Accreditation
  • Lab Director: DR. CHRISTOPHER CICCONE
  • NPI Number: 1023972551
  • Taxonomy: 332900000X - Non-Pharmacy Dispensing Site

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CLIA Record

Field Name Field Value
CLIA Number 49D0911343
LAB Type Other
Facility Name TIDEWATER PHYSICIANS MULTISPECIALITY GROUP, PC
Street 860 OMNI BOULEVARD - SUITE 105
City NEWPORT NEWS
State VA
ZIP 23606
Phone 7578730952
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Other
Lab Director DR. CHRISTOPHER CICCONE

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This page was last updated on: 5/18/2026