49D2140611 CLIA NUMBER - BON SECOURS SHORT PUMP EMERGENCY CENTER

Laboratory Demographics

  • CLIA Code: 49D2140611
  • Facility Name: BON SECOURS SHORT PUMP EMERGENCY CENTER
  • Facility Address: 12320 WEST BROAD STREET- LABORATORY
    RICHMOND, VA
    ZIP 23233
  • Facility Phone: 804 287-7670
  • Facility Type: Other - FREE STANDING ER CTR LAB
  • Facility Type: Accreditation
  • Lab Director: DR. JACK WILSON
  • NPI Number: 1528091808
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2140611
LAB Type Other - FREE STANDING ER CTR LAB
Facility Name BON SECOURS SHORT PUMP EMERGENCY CENTER
Street 12320 WEST BROAD STREET- LABORATORY
City RICHMOND
State VA
ZIP 23233
Phone 804 287-7670
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 4/3/2025
Certificate Expiration Date 4/2/2027
Facility Type Other - FREE STANDING ER CTR LAB
Lab Director DR. JACK WILSON

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