Healther Providers Data Logo

49D2159857 CLIA NUMBER - EXECUTIVE HEALTHCARE SERVICES

Laboratory Demographics

CLIA Number: 49D2159857

Facility Name: EXECUTIVE HEALTHCARE SERVICES

Facility Address:
12040 SOUTH LAKES DR #204
RESTON, VA
ZIP 20191
Get Directions

Facility Phone Number: 703 230-0347

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1760664007

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name Field Value
CLIA Number 49D2159857
LAB Type Physician Office
Facility Name EXECUTIVE HEALTHCARE SERVICES
Street 12040 SOUTH LAKES DR #204
City RESTON
State VA
ZIP 20191
Phone 703 230-0347
CertificateType 4
CertificateEffectiveDate 12/28/2022
CertificateExpirationDate 12/27/2024
FacilityType Waiver

Download Record

Download this CLIA NUMBER record in Text format: Export

Download this CLIA NUMBER record in Excel (CSV) format: Export

Download this CLIA NUMBER record in XML format: Export

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