49D2219049 CLIA NUMBER - SHENANDOAH PAIN & PALLIATIVE CARE CLINIC, LLC

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Laboratory Demographics

CLIA Number: 49D2219049

Facility Name: SHENANDOAH PAIN & PALLIATIVE CARE CLINIC, LLC

Facility Address:
173 E SPRINGBROOK ROAD
BROADWAY, VA
ZIP 22815
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Facility Phone Number: 540 901-7028

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1659919017

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name	Field Value
CLIA Number	49D2219049
LAB Type	Practitioner Other
Facility Name	SHENANDOAH PAIN & PALLIATIVE CARE CLINIC, LLC
Street	173 E SPRINGBROOK ROAD
City	BROADWAY
State	VA
ZIP	22815
Phone	540 901-7028
CertificateType	4
CertificateEffectiveDate	4/1/2023
CertificateExpirationDate	3/31/2025
FacilityType	Waiver

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