49D2231961 CLIA NUMBER - REVOLUTION MEDICINE DIRECT PRIMARY CARE PLLC

Laboratory Demographics

  • CLIA Code: 49D2231961
  • Facility Name: REVOLUTION MEDICINE DIRECT PRIMARY CARE PLLC
  • Facility Address: 9701 GAYTON RD SUITE 5
    RICHMOND, VA
    ZIP 23238
  • Facility Phone: 804 214-6415
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DANIEL N. MOORE

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CLIA Record

Field Name Field Value
CLIA Number 49D2231961
LAB Type Physician Office
Facility Name REVOLUTION MEDICINE DIRECT PRIMARY CARE PLLC
Street 9701 GAYTON RD SUITE 5
City RICHMOND
State VA
ZIP 23238
Phone 804 214-6415
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/9/2023
Certificate Expiration Date 8/8/2025
Facility Type Physician Office
Lab Director DANIEL N. MOORE

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