49D2286788 CLIA NUMBER - TRINITY FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 49D2286788

Facility Name: TRINITY FAMILY PRACTICE

Facility Address:
14260R CENTREVILLE SQ
CENTREVILLE, VA
ZIP 20121
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Facility Phone Number: 571 459-2640

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1144955261

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	49D2286788
LAB Type	Physician Office
Facility Name	TRINITY FAMILY PRACTICE
Street	14260R CENTREVILLE SQ
City	CENTREVILLE
State	VA
ZIP	20121
Phone	571 459-2640
CertificateType	4
CertificateEffectiveDate	8/3/2023
CertificateExpirationDate	8/2/2025
FacilityType	Waiver

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