49D2273322 CLIA NUMBER - COUNTY MED, LLC

Laboratory Demographics

  • CLIA Code: 49D2273322
  • Facility Name: COUNTY MED, LLC
  • Facility Address: 103 E BROAD ST
    BLACKSTONE, VA
    ZIP 23824
  • Facility Phone: 434 264-3221
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: SHANTEL L. LATTA
  • NPI Number: 1407580483
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D2273322
LAB Type Practitioner Other
Facility Name COUNTY MED, LLC
Street 103 E BROAD ST
City BLACKSTONE
State VA
ZIP 23824
Phone 434 264-3221
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Practitioner Other
Lab Director SHANTEL L. LATTA

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