49D1062557 CLIA NUMBER - CROSSRIDGE PEDIATRICS AND INTERNAL MEDICINE

Laboratory Demographics

CLIA Number: 49D1062557

Facility Name: CROSSRIDGE PEDIATRICS AND INTERNAL MEDICINE

Facility Address:
10150 STAPLES MILL ROAD SUITE C
GLEN ALLEN, VA
ZIP 23060
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Facility Phone Number: 804 755-7581

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1881795557

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	49D1062557
LAB Type	Physician Office
Facility Name	CROSSRIDGE PEDIATRICS AND INTERNAL MEDICINE
Street	10150 STAPLES MILL ROAD SUITE C
City	GLEN ALLEN
State	VA
ZIP	23060
Phone	804 755-7581
CertificateType	4
CertificateEffectiveDate	12/18/2023
CertificateExpirationDate	12/17/2025
FacilityType	Waiver

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