49D2045667 CLIA NUMBER - WESTERN TIDEWATER COMMUNITY SERVICES BOARD

Laboratory Demographics

  • CLIA Code: 49D2045667
  • Facility Name: WESTERN TIDEWATER COMMUNITY SERVICES BOARD
  • Facility Address: 1000 COMMERCIAL LANE
    SUFFOLK, VA
    ZIP 23434
  • Facility Phone: 757 942-1069
  • Facility Type: Other - OUTPT CLINIC
  • Facility Type: Waiver
  • Lab Director: DIEIRCH KAISER
  • NPI Number: 1164944740
  • Taxonomy: 343900000X - Non-emergency Medical Transport (VAN)

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CLIA Record

Field Name Field Value
CLIA Number 49D2045667
LAB Type Other - OUTPT CLINIC
Facility Name WESTERN TIDEWATER COMMUNITY SERVICES BOARD
Street 1000 COMMERCIAL LANE
City SUFFOLK
State VA
ZIP 23434
Phone 757 942-1069
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2024
Certificate Expiration Date 8/16/2026
Facility Type Other - OUTPT CLINIC
Lab Director DIEIRCH KAISER

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