51D1038837 CLIA NUMBER - MOUNTAIN STATE MEDICAL SPECIALTIES

Laboratory Demographics

  • CLIA Code: 51D1038837
  • Facility Name: MOUNTAIN STATE MEDICAL SPECIALTIES
  • Facility Address: 4815 KANAWHA AVENUE SW
    SOUTH CHARLESTON, WV
    ZIP 25309
  • Facility Phone: 304 768-4567
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. MICHELLE L. ENDICOTT
  • NPI Number: 1275753576
  • Taxonomy: 2085R0202X - Radiology

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CLIA Record

Field Name Field Value
CLIA Number 51D1038837
LAB Type Physician Office
Facility Name MOUNTAIN STATE MEDICAL SPECIALTIES
Street 4815 KANAWHA AVENUE SW
City SOUTH CHARLESTON
State WV
ZIP 25309
Phone 304 768-4567
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Physician Office
Lab Director DR. MICHELLE L. ENDICOTT

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