49D2116099 CLIA NUMBER - GOOCHLAND POWHATAN COMMUNITY SERVICES

Laboratory Demographics

  • CLIA Code: 49D2116099
  • Facility Name: GOOCHLAND POWHATAN COMMUNITY SERVICES
  • Facility Address: 3058 RIVER ROAD WEST
    GOOCHLAND, VA
    ZIP 23063
  • Facility Phone: 804 556-5400
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: JEFFREY BUTHE
  • NPI Number: 1467448571
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D2116099
LAB Type Community Clinic
Facility Name GOOCHLAND POWHATAN COMMUNITY SERVICES
Street 3058 RIVER ROAD WEST
City GOOCHLAND
State VA
ZIP 23063
Phone 804 556-5400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2024
Certificate Expiration Date 7/18/2026
Facility Type Community Clinic
Lab Director JEFFREY BUTHE

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