49D2329404 CLIA NUMBER - EASTLAKE PRIMARY CARE PC

Laboratory Demographics

  • CLIA Code: 49D2329404
  • Facility Name: EASTLAKE PRIMARY CARE PC
  • Facility Address: 14807 MONETA RD, SUITE J
    MONETA, VA
    ZIP 24121
  • Facility Phone: 540 580-1624
  • Facility Type: Other - OUTPATIENT PRIMARY CARE
  • Facility Type: Waiver
  • Lab Director: HOLLY H. ROY
  • NPI Number: 1043002934
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D2329404
LAB Type Other - OUTPATIENT PRIMARY CARE
Facility Name EASTLAKE PRIMARY CARE PC
Street 14807 MONETA RD, SUITE J
City MONETA
State VA
ZIP 24121
Phone 540 580-1624
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2025
Certificate Expiration Date 8/27/2027
Facility Type Other - OUTPATIENT PRIMARY CARE
Lab Director HOLLY H. ROY

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