49D2022977 CLIA NUMBER - IVY FAMILY MEDICINE, PLC

Laboratory Demographics

  • CLIA Code: 49D2022977
  • Facility Name: IVY FAMILY MEDICINE, PLC
  • Facility Address: 145 EDNAM DRIVE SUITE 208
    CHARLOTTESVILLE, VA
    ZIP 22903
  • Facility Phone: 434 202-7830
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LILY W. HARGROVE
  • NPI Number: 1073818787
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D2022977
LAB Type Physician Office
Facility Name IVY FAMILY MEDICINE, PLC
Street 145 EDNAM DRIVE SUITE 208
City CHARLOTTESVILLE
State VA
ZIP 22903
Phone 434 202-7830
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Physician Office
Lab Director LILY W. HARGROVE

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This page was last updated on: 3/20/2025