49D2212158 CLIA NUMBER - RIVERSIDE PRIMARY CARE COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 49D2212158
  • Facility Name: RIVERSIDE PRIMARY CARE COMMUNITY CLINIC
  • Facility Address: 727 25TH STREET
    NEWPORT NEWS, VA
    ZIP 23607
  • Facility Phone: 757 316-5210
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFREY L. HENKE
  • NPI Number: 1326603952
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2212158
LAB Type Physician Office
Facility Name RIVERSIDE PRIMARY CARE COMMUNITY CLINIC
Street 727 25TH STREET
City NEWPORT NEWS
State VA
ZIP 23607
Phone 757 316-5210
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2025
Certificate Expiration Date 2/2/2027
Facility Type Physician Office
Lab Director JEFFREY L. HENKE

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