49D2107107 CLIA NUMBER - WISE COUNTY BEHAVIORAL HEALTH SERVICES

Laboratory Demographics

  • CLIA Code: 49D2107107
  • Facility Name: WISE COUNTY BEHAVIORAL HEALTH SERVICES
  • Facility Address: 43 CHAMPION AVE
    BIG STONE GAP, VA
    ZIP 24219
  • Facility Phone: 423 467-3715
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CLINTON ALLEN MUSIL
  • NPI Number: 1174982193
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D2107107
LAB Type Physician Office
Facility Name WISE COUNTY BEHAVIORAL HEALTH SERVICES
Street 43 CHAMPION AVE
City BIG STONE GAP
State VA
ZIP 24219
Phone 423 467-3715
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/6/2024
Certificate Expiration Date 1/5/2026
Facility Type Physician Office
Lab Director CLINTON ALLEN MUSIL

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