49D2091511 CLIA NUMBER - MOUNTAIN RIDGE PEDIATRICS

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Laboratory Demographics

CLIA Number: 49D2091511

Facility Name: MOUNTAIN RIDGE PEDIATRICS

Facility Address:
2034 PRO POINTE LANE
HARRISONBURG, VA
ZIP 22801
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Facility Phone Number: 540 217-5333

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043423676

Taxonomy: 1223P0221X - Dentist
An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

CLIA Record

Field Name	Field Value
CLIA Number	49D2091511
LAB Type	Physician Office
Facility Name	MOUNTAIN RIDGE PEDIATRICS
Street	2034 PRO POINTE LANE
City	HARRISONBURG
State	VA
ZIP	22801
Phone	540 217-5333
CertificateType	4
CertificateEffectiveDate	2/13/2023
CertificateExpirationDate	2/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024