49D1092769 CLIA NUMBER - BON SECOURS OB GYN SOUTHSIDE

Laboratory Demographics

  • CLIA Code: 49D1092769
  • Facility Name: BON SECOURS OB GYN SOUTHSIDE
  • Facility Address: 210 MEDICAL PARK BOULEVARD - SUITE 150
    PETERSBURG, VA
    ZIP 23805
  • Facility Phone: 804 765-5206
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAPHNE BAZILE HARRISON
  • NPI Number: 1033130026
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D1092769
LAB Type Physician Office
Facility Name BON SECOURS OB GYN SOUTHSIDE
Street 210 MEDICAL PARK BOULEVARD - SUITE 150
City PETERSBURG
State VA
ZIP 23805
Phone 804 765-5206
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Physician Office
Lab Director DAPHNE BAZILE HARRISON

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