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51D0943200 CLIA NUMBER - JEFFERSON URGENT CARE

Laboratory Demographics

CLIA Number: 51D0943200

Facility Name: JEFFERSON URGENT CARE

Facility Address:
84 SOMERSET BOULEVARD
CHARLES TOWN, WV
ZIP 25414
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Facility Phone Number: 304 728-8533

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1639367402

Taxonomy: 251300000X - Local Education Agency (LEA)
The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools. An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy.

CLIA Record

Field Name Field Value
CLIA Number 51D0943200
LAB Type Physician Office
Facility Name JEFFERSON URGENT CARE
Street 84 SOMERSET BOULEVARD
City CHARLES TOWN
State WV
ZIP 25414
Phone 304 728-8533
CertificateType 4
CertificateEffectiveDate 1/15/2023
CertificateExpirationDate 1/14/2025
FacilityType Waiver

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