49D0951073 CLIA NUMBER - PETERSBURG DIALYSIS

Laboratory Demographics

  • CLIA Code: 49D0951073
  • Facility Name: PETERSBURG DIALYSIS
  • Facility Address: 20 MEDICAL PARK BOULEVARD
    PETERSBURG, VA
    ZIP 23803
  • Facility Phone: (804) 861-0967
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SANDY M. GIBSON, MD

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CLIA Record

Field Name Field Value
CLIA Number 49D0951073
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PETERSBURG DIALYSIS
Street 20 MEDICAL PARK BOULEVARD
City PETERSBURG
State VA
ZIP 23803
Phone 8048610967
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SANDY M. GIBSON, MD

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