49D2072728 CLIA NUMBER - PERFORMANCE MEDICINE OF SOUTHWEST VIRGINIA

Laboratory Demographics

  • CLIA Code: 49D2072728
  • Facility Name: PERFORMANCE MEDICINE OF SOUTHWEST VIRGINIA
  • Facility Address: 25 WEST CALHOUN STREET
    SALEM, VA
    ZIP 24153
  • Facility Phone: 540 777-0866
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DELMAS BOLIN
  • NPI Number: 1710454475
  • Taxonomy: 2251X0800X - Physical Therapist

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CLIA Record

Field Name Field Value
CLIA Number 49D2072728
LAB Type Physician Office
Facility Name PERFORMANCE MEDICINE OF SOUTHWEST VIRGINIA
Street 25 WEST CALHOUN STREET
City SALEM
State VA
ZIP 24153
Phone 540 777-0866
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2024
Certificate Expiration Date 2/3/2026
Facility Type Physician Office
Lab Director DELMAS BOLIN

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