49D2168521 CLIA NUMBER - REVIDA RECOVERY CENTERS, PC

Laboratory Demographics

  • CLIA Code: 49D2168521
  • Facility Name: REVIDA RECOVERY CENTERS, PC
  • Facility Address: 255 HOLSTON RD
    WYTHEVILLE, VA
    ZIP 24382
  • Facility Phone: 276 227-0206
  • Facility Type: Other - OFFICE BASED OPIOID TRMT
  • Facility Type: Waiver
  • Lab Director: ANDREW WALLER
  • NPI Number: 1013483486
  • Taxonomy: 207QA0401X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2168521
LAB Type Other - OFFICE BASED OPIOID TRMT
Facility Name REVIDA RECOVERY CENTERS, PC
Street 255 HOLSTON RD
City WYTHEVILLE
State VA
ZIP 24382
Phone 276 227-0206
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2023
Certificate Expiration Date 7/1/2025
Facility Type Other - OFFICE BASED OPIOID TRMT
Lab Director ANDREW WALLER

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This page was last updated on: 3/20/2025