49D2053393 CLIA NUMBER - SOUTH BOSTON PEDIATRICS

Laboratory Demographics

  • CLIA Code: 49D2053393
  • Facility Name: SOUTH BOSTON PEDIATRICS
  • Facility Address: 2202 BEECHMONT ROAD
    SOUTH BOSTON, VA
    ZIP 24592
  • Facility Phone: 434 572-3635
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: NONNA L. EBALO
  • NPI Number: 1356690366
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 49D2053393
LAB Type Physician Office
Facility Name SOUTH BOSTON PEDIATRICS
Street 2202 BEECHMONT ROAD
City SOUTH BOSTON
State VA
ZIP 24592
Phone 434 572-3635
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2025
Certificate Expiration Date 1/29/2027
Facility Type Physician Office
Lab Director NONNA L. EBALO

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