51D1038837 CLIA NUMBER - MOUNTAIN STATE MEDICAL SPECIALTIES

Laboratory Demographics

CLIA Number: 51D1038837

Facility Name: MOUNTAIN STATE MEDICAL SPECIALTIES

Facility Address:
4815 KANAWHA AVENUE SW
SOUTH CHARLESTON, WV
ZIP 25309
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Facility Phone Number: 304 768-4567

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1275753576

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

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
CertificateType	3
CertificateEffectiveDate	3/29/2023
CertificateExpirationDate	3/28/2025
FacilityType	PPMP

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