49D2295518 CLIA NUMBER - FREE RANGE DIRECT PRIMARY CARE, PLLC

Laboratory Demographics

  • CLIA Code: 49D2295518
  • Facility Name: FREE RANGE DIRECT PRIMARY CARE, PLLC
  • Facility Address: 4420 IVY COMMONS
    CHARLOTTESVILLE, VA
    ZIP 22903
  • Facility Phone: 434 337-5934
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW B. JOHNSON
  • NPI Number: 1336975382
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D2295518
LAB Type Physician Office
Facility Name FREE RANGE DIRECT PRIMARY CARE, PLLC
Street 4420 IVY COMMONS
City CHARLOTTESVILLE
State VA
ZIP 22903
Phone 434 337-5934
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2023
Certificate Expiration Date 12/12/2025
Facility Type Physician Office
Lab Director MATTHEW B. JOHNSON

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