49D2219341 CLIA NUMBER - TOWN SQUARE MEDICAL PLLC

Laboratory Demographics

  • CLIA Code: 49D2219341
  • Facility Name: TOWN SQUARE MEDICAL PLLC
  • Facility Address: 202 TOWN SQUARE STREET
    GLADE SPRING, VA
    ZIP 24340
  • Facility Phone: 423 276-6342
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW L. JUSTUS
  • NPI Number: 1528641354
  • Taxonomy: 363AM0700X - Physician Assistant

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CLIA Record

Field Name Field Value
CLIA Number 49D2219341
LAB Type Physician Office
Facility Name TOWN SQUARE MEDICAL PLLC
Street 202 TOWN SQUARE STREET
City GLADE SPRING
State VA
ZIP 24340
Phone 423 276-6342
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Physician Office
Lab Director MATTHEW L. JUSTUS

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