49D2096506 CLIA NUMBER - PRIME CARE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 49D2096506
  • Facility Name: PRIME CARE FAMILY PRACTICE
  • Facility Address: 4700 PUDDLEDOCK ROAD - SUITE 300
    PRINCE GEORGE, VA
    ZIP 23875
  • Facility Phone: 804 526-1111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: LISA C. SHAH
  • NPI Number: 1881629384
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2096506
LAB Type Physician Office
Facility Name PRIME CARE FAMILY PRACTICE
Street 4700 PUDDLEDOCK ROAD - SUITE 300
City PRINCE GEORGE
State VA
ZIP 23875
Phone 804 526-1111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/27/2025
Certificate Expiration Date 5/26/2027
Facility Type Physician Office
Lab Director LISA C. SHAH

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