49D2055993 CLIA NUMBER - MOBJACK MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 49D2055993
  • Facility Name: MOBJACK MEDICAL GROUP
  • Facility Address: 6530 MAIN STREET
    GLOUCESTER, VA
    ZIP 23061
  • Facility Phone: 804 684-5043
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: FRANCIS T. WEST III
  • NPI Number: 1588903736
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2055993
LAB Type Physician Office
Facility Name MOBJACK MEDICAL GROUP
Street 6530 MAIN STREET
City GLOUCESTER
State VA
ZIP 23061
Phone 804 684-5043
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2025
Certificate Expiration Date 3/19/2027
Facility Type Physician Office
Lab Director FRANCIS T. WEST III

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