49D1039734 CLIA NUMBER - ST MARYS HEALTH WAGON, INC

Laboratory Demographics

CLIA Number: 49D1039734

Facility Name: ST MARYS HEALTH WAGON, INC

Facility Address:
5626 PATRIOT DRIVE
WISE, VA
ZIP 24293
Get Directions

Facility Phone Number: 276 328-8850

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1114356037

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	49D1039734
LAB Type	Mobile Laboratory
Facility Name	ST MARYS HEALTH WAGON, INC
Street	5626 PATRIOT DRIVE
City	WISE
State	VA
ZIP	24293
Phone	276 328-8850
CertificateType	4
CertificateEffectiveDate	11/6/2023
CertificateExpirationDate	11/5/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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