51D2026226 CLIA NUMBER - MOUNTAIN STATE DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 51D2026226
  • Facility Name: MOUNTAIN STATE DERMATOLOGY
  • Facility Address: 800 GRAND CENTRAL MALL SUITE 3
    VIENNA, WV
    ZIP 26105
  • Facility Phone: 304 865-0555
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. BARRETT A. LOUDEN
  • NPI Number: 1043785587
  • Taxonomy: 111N00000X - Chiropractor

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CLIA Record

Field Name Field Value
CLIA Number 51D2026226
LAB Type Physician Office
Facility Name MOUNTAIN STATE DERMATOLOGY
Street 800 GRAND CENTRAL MALL SUITE 3
City VIENNA
State WV
ZIP 26105
Phone 304 865-0555
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 6/27/2025
Certificate Expiration Date 6/26/2027
Facility Type Physician Office
Lab Director DR. BARRETT A. LOUDEN

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