49D1085550 CLIA NUMBER - BROAD/64 IMAGING, LLC DBA BON SECOURS IMAGING CENTER - REYNOLDS CROSSING

Laboratory Demographics

  • CLIA Code: 49D1085550
  • Facility Name: BROAD/64 IMAGING, LLC DBA BON SECOURS IMAGING CENTER - REYNOLDS CROSSING
  • Facility Address: 6605 WEST BROAD STREET - SUITE B GROUND FLOOR ATTN BRANDY JOHNSON
    RICHMOND, VA
    ZIP 23230
  • Facility Phone: 804 287-3500
  • Facility Type: Ancillary Testing Site in Health Care Center
  • Facility Type: Waiver
  • Lab Director: MARK A. WILLIAMS MD
  • NPI Number: 1316015985
  • Taxonomy: 261QR0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D1085550
LAB Type Ancillary Testing Site in Health Care Center
Facility Name BROAD/64 IMAGING, LLC DBA BON SECOURS IMAGING CENTER - REYNOLDS CROSSING
Street 6605 WEST BROAD STREET - SUITE B GROUND FLOOR ATTN BRANDY JOHNSON
City RICHMOND
State VA
ZIP 23230
Phone 804 287-3500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2024
Certificate Expiration Date 3/1/2026
Facility Type Ancillary Testing Site in Health Care Center
Lab Director MARK A. WILLIAMS MD

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