49D2291479 CLIA NUMBER - GALLOWS INTERNAL MEDICINE INC

Laboratory Demographics

  • CLIA Code: 49D2291479
  • Facility Name: GALLOWS INTERNAL MEDICINE INC
  • Facility Address: 14631 LEE HWY, SUITE 109
    CENTREVILLE, VA
    ZIP 20121
  • Facility Phone: 703 462-8711
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN K. MIN
  • NPI Number: 1356603401
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 49D2291479
LAB Type Physician Office
Facility Name GALLOWS INTERNAL MEDICINE INC
Street 14631 LEE HWY, SUITE 109
City CENTREVILLE
State VA
ZIP 20121
Phone 703 462-8711
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/11/2023
Certificate Expiration Date 10/10/2025
Facility Type Physician Office
Lab Director JOHN K. MIN

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