49D2167061 CLIA NUMBER - SOUTHSIDE MEDICAL PRACTICE

Laboratory Demographics

  • CLIA Code: 49D2167061
  • Facility Name: SOUTHSIDE MEDICAL PRACTICE
  • Facility Address: 502 BEECH STREET
    FARMVILLE, VA
    ZIP 23901
  • Facility Phone: 434 392-9438
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: VICTOR R. ADANIEL
  • NPI Number: 1366525040
  • Taxonomy: 173000000X - Legal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 49D2167061
LAB Type Physician Office
Facility Name SOUTHSIDE MEDICAL PRACTICE
Street 502 BEECH STREET
City FARMVILLE
State VA
ZIP 23901
Phone 434 392-9438
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2025
Certificate Expiration Date 5/30/2027
Facility Type Physician Office
Lab Director VICTOR R. ADANIEL

Download Record

Download this CLIA record record in Text format: Export

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

Download this CLIA record record in XML format: Export

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