49D1103104 CLIA NUMBER - EXECUTIVE HEALTH GROUP

Laboratory Demographics

  • CLIA Code: 49D1103104
  • Facility Name: EXECUTIVE HEALTH GROUP
  • Facility Address: 1630 WILKES RIDGE PARKWAY SUITE 302
    RICHMOND, VA
    ZIP 23233
  • Facility Phone: 804 560-3295
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. J RAND BAGGESEN MD
  • NPI Number: 1033497649
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D1103104
LAB Type Physician Office
Facility Name EXECUTIVE HEALTH GROUP
Street 1630 WILKES RIDGE PARKWAY SUITE 302
City RICHMOND
State VA
ZIP 23233
Phone 804 560-3295
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2025
Certificate Expiration Date 8/2/2027
Facility Type Physician Office
Lab Director DR. J RAND BAGGESEN MD

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