49D2169540 CLIA NUMBER - PREMISE HEALTH OF VIRGINIA MEDICAL, PC

Laboratory Demographics

  • CLIA Code: 49D2169540
  • Facility Name: PREMISE HEALTH OF VIRGINIA MEDICAL, PC
  • Facility Address: 4881 COUGAR TRAIL RD
    DUBLIN, VA
    ZIP 24084
  • Facility Phone: 640 302-6392
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KARLA GRIMES
  • NPI Number: 1467127704
  • Taxonomy: 261QM1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D2169540
LAB Type Physician Office
Facility Name PREMISE HEALTH OF VIRGINIA MEDICAL, PC
Street 4881 COUGAR TRAIL RD
City DUBLIN
State VA
ZIP 24084
Phone 640 302-6392
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2023
Certificate Expiration Date 7/22/2025
Facility Type Physician Office
Lab Director KARLA GRIMES

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This page was last updated on: 6/4/2025